UNIT INFORMATION

Mailing Address:

US Defenders

PO BOX 91928

Austin, TX 78709

 

 

Website problems contact:

Bungee@USDefenders.org

Date___________ 

COC Region State & Region: __________________________________

Regional Chairman: ___________________________________email:________________ 

USD’ers Unit Commander: _____________________________email: _______________

USD’ers Unit Vice Commander: _________________________email: _______________

COIR Representative: _________________________________ email: ________________

Number of M/Cs and Associations in region: __________

Number of C.O.I.R. in Region:   __________

M/Cs or Associations Information:

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ___________________________________

Primary USD’er:___________________email: _______________Ph#_______________

Alternate USD’er:__________________email:_______________Ph#________________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other________________________

 

Name of M/C or Association: ___________________________________

Primary USD’er:___________________email: _______________Ph#_____________

Alternate USD’er:__________________email:_______________Ph#______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other______________________

 

Name of M/C or Association: ___________________________________

Primary USD’er:___________________email: _______________Ph#_____________

Alternate USD’er:__________________email:_______________Ph#______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

 

Name of M/C or Association: ______________________________________________

Primary USD’er:___________________email: _______________Ph#______________

Alternate USD’er:__________________email:_______________Ph#_______________

Size:   Sm (5 to 10)    Med (11 to 16)   Lg (17 to 25)   Other_______________________

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