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New Chapter Application
First Name:  (Required)
Last Name:  (Required)
Email:  (Required)

This form is used to request to start a new chapter.  The new chapter registration fee is $100.  Upon approval of your submission, you will receive an invoice via email from PayPal to submit the fee of $100. New chapters receive an official chapter certificate with the approved chapter name, four large patches and four small patches.  New chapters also have an official page on the Chrome Diva website and are required to maintain their webpage with up to date content. 

Annual renewal fee of $50 is required and chapters receive a renewal packet with new patches or pins representative of the current year as well as an official chapter certificate.
By submitting this form you have agreed to abide by Chrome Divas, Inc. new chapter policy and Bylaws
Please note: The chapter registration fee is non-refundable
First Name  (Required)
Last Name  (Required)
Email Address  (Required)
Phone  (Required)
Address Line 1  (Required)
Address Line 2
City  (Required)
Location
Zip/Postal Code  (Required)
Country  (Required)
Chapter Name  (Required)
Reason for Starting A Chapter (Brief description of why you would like to start a chapter with Chrome Divas.)  (Required)
Registered Members (4) (Must include email address of each member)  (Required)

Are any of the members listed currently a member of a Chrome Diva Chapter?
Yes
No
Please enter the letters you see in the image above