AFAP REGISTRATION FORM

915-569-4ACS (4227)

Delegate Registration Form

DATA REQUIRED BY THE PRIVACY ACT OF 1974: AUTHORITY: 5 USC 301, 10 USC 3013. PRINCIPLE PURPOSE: Identification of participants in the Army Family Action Plan Conference. ROUTINE USES: Used to record the names and addresses of attendees at the Army Family Action Plan Conference. Used to contact participants and as basis for preparing a directory of conference attendees, which will be distributed to attendees and Army officials for networking purposes. Disclosure is voluntary. If the required information is not provided, registration for the conference and inclusion in the conference directory is not possible.

This form will be used to select delegates for the AFAP Conference. Delegates are the people whose input decides what issues get prioritized and sent forward for action. This position requires a week long commitment.

First Name Last Name Middle Initial
Street Address City State
    Zip    
Work Phone Home Phone FAX
Email Sponsor's Military Unit    

Have you participated at AFAP before?
Installation Level Location and Year Position Held:

MACOM Level Location and Year Position Held:

DA Level Location and Year Position Held:

Affiliation with the Military (Check all that apply):