Maine Chapter of the APTA Nomination Form (printable)

NAME: ____________________________


HOME ADDRESS:
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BUSINESS ADDRESS:

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PHONE:(w)_______________ (h) _____________


POSITION: _____________________


EDUCATION:  
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PROFESSIONAL EXPERIENCE:
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EXPERIENCE RELATED TO THE ASSOCIATION(STATE,SECTION  NATIONAL):
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Please take a few moments to respond to the questions below.
Limit your response to 200 words or less.  Candidate responses
will appear in the spring newsletter and are required to be submitted
prior to March 1, 2005.


QUESTION #1:
What do you see as the major issue(s) facing the Maine Chapter of the APTA?
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QUESTION #2:
What goals might address these issues?
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APTA Member Number: ______________

I, __________________ grant permission for my name to be placed in nomination for 
the office of ___________________________ in the Maine Chapter of the APTA.
I agree to serve if elected.

Please send completed nomination form to: 
Maine Chapter APTA
25 Bostwick Rd
Brunswick, ME 04011-7209