GLAC USBC BOARD OF DIRECTORS APP (INCUMBENT)

GLAC USBC BOARD OF DIRECTORS APPLICATION (INCUMBENTS ONLY)

Please answer all questions as completely as possible.
Candidate's Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell

Area CodePhone Number
Email
example@example.com
USBC Membership #
Current Position
Are you interested in attending the State Convention?
Are you interested in attending the USBC National Convention?
Any positions or job duties that you would like to be more involved with?
Suggestions or feedback regarding any association business
I CERTIFY THAT ALL STATEMENTS OR INFORMATION I HAVE PROVIDED ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. ANY DELIBERATE MISREPRESENTATION FOUND IN THIS APPLICATION MAY BE CAUSE FOR THE APPROVAL OF THIS APPLICATION AND MAY PROHIBIT ME FROM APPLYING AGAIN IN THE FUTURE.

I hereby consent to have my name placed in nomination for the office indicated below.
RUNNING FOR THE FOLLOWING POSITION:
Name

First NameLast Name
Signature (click hold and drag mouse to sign in box)
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

GLAC USBC BOARD OF DIRECTORS APPLICATION (INCUMBENTS ONLY)