NOMINEE'S Name *

First Name

Last Name

NOMINEE'S Preferred Phone *

(###)

###

####

Elected Position *

(check all that apply)

President-Elect

Secretary (even year election)

Treasurer (odd year election)

Director (2 elected each year)

Nominating Committee (3 elected in odd years; 2 elected in even years)

Committee

Committees

Education

Communication

Ways & Means

By-Laws

YOUR Name *

First Name

Last Name