2017 Elections Form

2017 PA Jaycees Officer Nomination or Appointment Form

In order to nominate a candidate for office or be considered for an appointment this electronic form must be submitted. Additionally your filing fee and a letter of recommendation from the nominee’s chapter must be provided to the Chairman of the Board, Jen Radzwillowicz, prior to announcing your candidacy.

In order to announce candidacy for Vice-President or President at the session following the Board of Director’s meeting in August, the form must be filed, with fees, by 10 pm EST on Friday, August 5, 2016, or a candidate must request an extension in writing from the chair.

Please review the by-laws and policies for additional information.

Filing Fees:

District Director - $5.00
Regional Director - $10.00
Vice President - $50.00
President - $100.00

Candidates’ Chapter*

Purpose of the Form

NominationAppointment

Office Seeking

District DirectorRegional DirectorVice PresidentPresident

Candidates’ Name*

First NameLast Name

Candidates’ Email Address*

Candidates’ Cell Phone Number

Area CodePhone Number

Date of Birth

MonthDayYear

Marital Status

Spouse's Name (If applicable)

First NameLast Name

Spouse's Date of Birth (If applicable)

MonthDayYear

Candidates Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Occupation

Employers Name

Employers Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

List by year, State and National Conventions you've attended.

Please list Offices held, Committee Chairmanships, Outstanding Achievements and Special Awards received in Jaycee work at the Local, State, and National Level.

List Any Outside Activites

I have carefully examined the foregoing statement of facts and certify that it is true and to the best of my knowledge correct. I further state that if elected an officer to the Pennsylvania Jaycees for the 2017 year, I shall contribute the time, money and effort necessary to serve to the best of my ability. I acknowledge and affirm that I will be present at the following meetings, training sessions, and functions unless excused by the President:

All Board of Director’s Meetings
All Executive Committee Meetings
State Planning Sessions
Executive Committee Retreat
Local Officer’s Training School
Mid Year Evaluation and Training

As a candidate for District Director, Regional Director, Vice President, or President I acknowledge the National Meetings listed below and plan to attend:

State President’s Training - Camp Discovery, Tennessee - December 2014 (President-elect only)
Eastern Institute Meeting
JCI USA Summit
US National Convention
US Annual Meeting

Final Checklist

In order to nominate a candidate for office or be considered for an appointment the following are required:

This electronic form must be submitted
Filing fee must be submitted
A letter of recommendation from the nominee’s chapter must be submitted

Fee and documents must be submitted, by the deadlines, to the Chairman of the Board, Jen Radzwillowicz.

Did you read, understand and agree with the above statement?

YesNo

Candidates Statement