EmailMe Form - Election Procedures Committee-CHC

Election Procedures Committee-CHC

Candidate Verification Sheet

Please complete the following information. It is needed to comply with the Manual
For State/State Area Conference Election Procedures.
Candidate Name
First Last
For Office Of
Membership Expiration Date
MM / DD / YYYY
Member Standing
Good
Not Good
Membership Type
Annual
Lifetime
3 Members in Good Standing Supporting Nomination
Name
First Last
Checkbox
Signed Petition = Yes
Membership Standing= Good
Name
First Last
Checkbox
Signed Petition = Yes
Membership Standing= Good
Name
First Last
Checkbox
Signed Petition = Yes
Membership Standing= Good
By signing below, I certify that all the information above is true and correct to
the best of my knowledge.
Form Completed By
First Last
Form Completed On
MM / DD / YYYY
By signing below, I certify that all the information above is true and correct to
the best of my knowledge.
Clear
Please sign using mouse on desktop or finger on touchscreen devices.