PERSONAL DETAILS:
First Name
Middle Name
Last Name
Address
State
Zip Code
Telephone
Email
Chapter—Please choose an option—ArizonaCincinnatiColoradoColumbusConnecticutDelawareFloridaGeorgiaIllinoisKentuckyLos AngelesMarylandMassachusettsMinnesotaNew JerseyNew YorkNorth CaliforniaPennsylvaniaSan FranciscoTennesseeTexas-DallasWashington, DC
Member Since—Please choose an option—200520062007200820092010201120122013201420152016201720182019202020212022
NPP USA Member ID
Last Position You Held
Upload Recent Passport Photo
NOMINATION DETAILS:
Select the Position you are Contesting For—Please choose an option—Branch ChairpersonBranch 1st. Vice ChairpersonBranch 2nd. Vice ChairpersonBranch SecretaryBranch TreasurerBranch OrganizerBranch Women OrganizerBranch Youth OrganizerBranch NASARA Coordinator
SPONSOR:
SECONDERS:
DECLARATION:
By submitting this form, I declare faithfully that I have provided all the required information. I further declare that I will abide by the outcome and accept the results of the election as announced by the Branch Election Committee. Any false declaration shall lead to my DISQUALIFICATION. I also agree that failure to pay the prescribed fee by the close of nominations will result in disqualification.
Δ