Officer Application Form

North Carolina Mothers of Multiples
OFFICER APPLICATION FORM

Heather Nordberg
hnordberg@gmail.com
4824 Rhythm Drive
Apex, NC 27539

NAME __________________________________ DATE OF APPLICATION________________

ADDRESS___________________________________________________________________

TELEPHONE: DAYTIME_________________________ EVENING______________________

CLUB AFFILIATION___________________________________________________________

ADDRESS___________________________________________________________________

NAME OF CLUB PRESIDENT____________________________________________________

ADDRESS___________________________________________________________________

TELEPHONE______________________________

POSITION APPLIED FOR______________________________________________________

REASON YOU ARE SEEKING THIS POSITION:

__________________________________________________________________________

Signature of Applicant_____________________________________

Please complete one:
__________I am placing myself in nomination

__________I am being nominated by____________________________________________
(Signature of person making nomination)

Submit to the Nominating chairman before the May 15th deadline. Current address can be found under officers and chairpersons in the state information section. This form must be accompanied by a Verification of Applicant Qualifications Form, completed and signed by your local club president.

NCMOMs November 1990