State Chapter Annual Report

The purpose of the annual report is to keep the national office informed regarding state chapter activities. We will share this information with other state chapters at AMDA's annual symposium each year as requested at the 2001 State Presidents Meeting. Please feel free to use the template below, or you may use your own format as long as it includes the requested information.

1. Name of chapter: _________________________________________________.

2. State chapter annual report for the year 20___.

3. Number of active members: _______.
   (Please provide current membership list including name, address, phone and fax numbers.)

4. Membership dues structure (annual dues):
   Regular Member: $_______
   Associate Member: $_______
   Other (_______________): $_______

5. Date of last business meeting: _________________
   (Please submit meeting minutes.)

6. Attach a current list of officers and their tenure of office.

7. Provide a list of conferences or meetings for the past year. Please include:

   1. When and where they were held.
   2. If held in conjunction with other organization(s), list organization(s).

8. Please attach any policy statements, position statements, or bylaws changes issued this year.

9. List state chapter contact information:

   Name_________________________________________________
   Title___________________________________________________
   Address Line 1__________________________________________
   Address Line 2__________________________________________
   City/St/Zip_____________________________________________
   Phone________________________________________________
   Fax__________________________________________________
   E-mail________________________________________________

10. List upcoming events information (if you have more than one event, please list on a separate sheet):

    Meeting_______________________________________________
    Date_________________________________________________
    Location_______________________________________________
    Sponsor(s)_____________________________________________
    Contact Information_______________________________________

Report completed by: __________________________________________
Date: ________________________

Please return annual report to:
Kris Bieg, Membership and Communications Coordinator
American Medical Directors Association
11000 Broken Land Parkway, #400
Columbia, MD 21044
410/740-9743
410/740-4572 fax
www.amda.com