Seeking position for: DELEGATE
Must be able to attend AMTA National Convention, October 3-6, 2012 in Raleigh, North Carolina. |
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First Name : | |
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Last Name : | |
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Phone Number : | |
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Email : | |
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Address : | |
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AMTA# : | |
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Years practicing massage : | |
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Massage License # : | |
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Education (List high school, college, graduate school, other courses, certifications, degrees) : |
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List AMTA Chapter or national offices held and/or committee work (include dates) : |
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Why do you want to be a delegate to the National Convention? |
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What are your strengths and qualifications for this position? |
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What do you see yourself contributing to this position? |
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Do you understand the duties and time commitment? |
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Are you able to commit for the enter term of the office? | |
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Are you willing and able to commit the time needed to get the job done? | |
By entering your name and date in the box below, you're indicating that if you are elected for this office, you are able and agree to serve for the prescribed term of office; that the information provided is accurate and that permission is granted for the verification of that information. |
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Signature and Date : |
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Form must be received by May 1, 2012. No nominations will be accepted at Annual Meeting. |
