Form 4: Official Voting Delegate Credentials

75th Annual Meeting: Form 4
Official Voting Delegate Credentials

Deadline: October 29, 2025
County Farm Bureau*
Choose a county
Name of Person Submitting Form*

First NameLast Name
Position*
Phone Number*

Area CodePhone Number
Email*
example@example.com
I, First Name Last Name Secretary of my County Farm Bureau, this Date, certify the following delegates and alternates were elected (and/or authorized) at a regularly called Annual Meeting of the county membership, said MEETING HAVING A QUORUM IN ATTENDANCE.
Elected Person 1
Elected*

DelegateAlternativePresidentVice President
Name*

First NameLast Name
Membership Number
Elected Person 2
Elected*

DelegateAlternativePresidentVice President
Name*

First NameLast Name
Membership Number
Elected Person 3
Elected*

DelegateAlternativePresidentVice President
Name*

First NameLast Name
Membership Number
Elected Person 4
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 5
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 6
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 7
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 8
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 9
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 10
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 11
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 12
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 13
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 14
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 15
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 16
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 17
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 18
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 19
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Elected Person 20
Elected

DelegateAlternativePresidentVice President
Name

First NameLast Name
Membership Number
Should be Empty:

Official Voting Delegate Credentials

Elected Person 1

Elected Person 2

Elected Person 3

Elected Person 4

Elected Person 5

Elected Person 6

Elected Person 7

Elected Person 8

Elected Person 9

Elected Person 10

Elected Person 11

Elected Person 12

Elected Person 13

Elected Person 14

Elected Person 15

Elected Person 16

Elected Person 17

Elected Person 18

Elected Person 19

Elected Person 20