President Elect - Willingness to Serve WSSRA STATE FORMS

District Representative - Willingness to Serve

2023-2024
Districts NW1, SW3 and E5 may nominate candidates for District Representative. These nominations from the various units within these districts need to be submitted to their Coordinating Councils.

* indicates required field
Coordinating Council District:*
Unit Name and Number*
Your Name*

First Name Last Name
Phone Number*

Area Code Phone Number
Email*

Confirmation Email example@example.com
Address*
Please summarize your experience in local unit (and/or statewide) committees, activities or leadership positions.*
I fully understand the duties and responsibilities of a District Representative. If nominated, I agree to serve my District, and state that I am a member of WSSRA in good standing and that my membership dues are current.*

Yes
Should be Empty:

District Representative - Willingness to Serve