Membership Delegate Election Report

Membership Delegate Election Report
Service Unit Name*
Service Unit Number*
Election Date*

MonthDayYear
1st Delegate
1. Delegate Name*

First NameLast Name
1. Delegate is:*

GirlAdult
1. Delegate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1. Delegate E-mail*
2nd Delegate
If first delegate is a girl, the Service Unit may elect a second delegate.
2. Delegate Name*

First NameLast Name
2. Delegate is:*

GirlAdult
2. Delegate Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Delegate E-mail*
I certify that this Service Unit held an open election according to the Bylaws of GSNEO and these are the results. The nomination forms were submitted electronically (preferred method) or by paper to governance@gsneo.org for the above listed Membership Delegate(s).
Submitted by:*

First NameLast Name
Position:*
Submitter e-mail:*
Full Name -- By entering my name and submitting this form, I understand that my typed name serves as my digital signature.*
Should be Empty:

1st Delegate