President Elect - Willingness to Serve WSSRA STATE FORMS

District Representative - Willingness to Serve

2022-2023
Districts SW4, E6 and E8 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