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North Carolina Mothers of
Multiples
OFFICER RENEWAL
APPLICATION FORM
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Local President send
to:
Kim Koontz wickedwitch@ptmc.net 246 Beech Tree Ln. Lexington, NC 27295 (336) 787-2278 |
NAME
__________________________________ DATE OF APPLICATION________________
ADDRESS___________________________________________________________________
TELEPHONE:
DAYTIME_________________________ EVENING______________________
CLUB
AFFILIATION___________________________________________________________
ADDRESS___________________________________________________________________
NAME OF CLUB
PRESIDENT____________________________________________________
ADDRESS___________________________________________________________________
TELEPHONE______________________________
POSITION RENEWING______________________________________________________
Signature of Applicant(type in)_____________________________________
Please initial one:
__________I am placing myself in
nomination
__________I am being nominated
by____________________________________________
(Signature
of person making nomination)
As President of
_________________________________________________, I do verify that the above
person is a member of good standing in their local club.
(Signature of local
President)(type in)
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________________________________________
This form must be completed by
you and verified by your local club president.
Your local club president will then submit this form to the Nominating
chairman. Submit to the Nominating
chairman before the May 15th deadline. Current address is above.
NCMOMs November 1990
Modified
April 2010