Petition for Regional Organization Status

Proposed Chapter Name:

Business Address:




Number of Chapter members included with this Petition (minimum of 20 required)
(attach list of members):

Number of non-SRA Members included:

To the Officers of the SRA:

We the undersigned interim Officers of the proposed SRA Chapter petition that the proposed Chapter be chartered by SRA in accordance with the rules and regulations of the SRA. We aver that this petition meets with the unanimous approval of the petitioning members of the proposed Chapter, and that the proposed Chapter is organized in a manner which conforms to the SRA Bylaws and to standard Chapter Bylaws and formation requirements.

We attach a list of the Members of the proposed Chapter with their addresses, and a copy of the proposed Chapter Bylaws. We request that the Chapter be chartered.

Signed the ______ day of _____, 2___ .
________________________ _________________________

Interim Chapter President Interim Chapter Secretary

Please return this form and attachments to: Richard J. Burk, Jr., SRA Secretariat, 1313 Dolley Madison Blvd., Suite 402, McLean VA 22101. Telephone 703-790-1745. E-mail: