2025 ASMBS State Chapter Annual Report
Due by March 31, 2026
Chapter Overview
This section collects general contact information. Please ensure ASMBS has your most up-to-date details on file.
State Chapter Name:
*
Primary Contact Information
*
First Name
Last Name
Title
Role
Contact Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Chapter Mission Statement (Only if different from what appears on your Chapter's ASMBS webpage)
Chapter Leadership (Current Year)
Please list only current officers and leaders. ASMBS STARs are required, IH STARs are optional but strongly encouraged.
Type a question
Rows
Name & Credentials
Term Start
Term End
President
Vice President
Secretary/President-Elect
Treasurer
IH Section Leader (if applicable)
STAR
IH STAR (optional)
Other Key Leader (optional)
Chapter Administration (If Applicable)
This section is to be filled out if the chapter is supported by a management company.
Executive Director
First Name
Last Name
Email
example@example.com
Administrator
First Name
Last Name
Email
example@example.com
Membership
Does ASMBS collect dues on behalf of your Chapter
Yes (If yes, continue to next section.)
No (If no, please attach your current member roster. Rosters should include name, credential and email address at a minimum.)
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Financial Compliance
2025 IRS Filing
Please attached your 2025 IRS Filing (990N) if annual revenue is under $50,000
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Annual Meeting(s)
Please provide details for any Chapter meetings held in 2025.
Meeting Date(s):
Location (City/State or Virtual):
Event Link (if available):
Meeting Agenda or Outline
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Chapter Activities & Highlights (2025)
Briefly summarize key activities (bullet points encouraged):
Speaker Recommendations (Optional, but encouraged)
Please nominate up to three speakers from yoru Chapter or Chapter events for national consideration.
First Name
Last Name
Email
Speciality/Expertise
Rationale
First Name
Last Name
Email
Speciality/Expertise
Rationale
First Name
Last Name
Email
Speciality/Expertise
Rationale
If no nominations, briefly describe what worked well for your Chapter this year.
Additional Notes
Any other information you would like ASMBS leadership to know? Are there any issues or topics your Chapter needs assistance with?
Type a question
By signing this form, I certify that the information provided is true and accurate to the best of my knowledge.
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