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Certified Chief Executive (CCE) Verification Form

Club Managers Association of America

1733 King Street • Alexandria, VA • 22314-2720

(703) 739-9500 • FAX: (703) 739-0124

I hereby certify that: _______________________________ _______________________________ served as the

most senior-level staff member of the _______________________________ with full authority over all personnel

from ___________________ to ___________________ in the capacity of _______________________________.

Name: _____________________________ Date: ___________________

(First Name)

(Club Name)

(Title)

(Start Date)

(Finish Date)

(Last Name)

I hereby swear or affirm that the above information is complete and correct to the best of my knowledge.

Signature: ___________________________________________________________________ Date: ______________________________

Sworn and subscribed before this ______________________ day of __________________________ in the year _______________

Notary Public: ___________________________________________________________________________________________________

Updated 6/15