EmailMe Form - 2014 Application for Officers/Board of Directors

This application is for consideration of : *

You must be active with a NLC member city through December 31, 2014 to be considered for appointment

Name: *

First Last

Current Title: *

Expiration Date of Term if in an elected office:

MM / DD / YYYY

If your term expires prior to January 1, 2014, do you plan to run again?

Yes

No

You must be active through December 31, 2014 to be considered for appointment.

Preferred Email: *

Primary means of communicating with NLC.

Confirm email:

Preferred Phone: *

### - ### - ####

Daytime phone number

Cell Phone:

### - ### - ####

If your preferred daytime phone number is not your cell phone

Alternate Email:

If you wish to use a personal or other email for communications with NLC. (e.g., your Administrative Assistant)

Confirm email:

City or Town:

State:

Do you have endorsement of your State Municipal League?

Yes

No

You must be active through December 31, 2014 to be considered for appointment.

I do not have endorsement of my State Municipal League at this time but expect to receive it.

Confirm

The endorsement is not required but strongly recommended to have.

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