Nomination for Regional Director

This nomination is submitted in accordance with Article VI of the JCNA Bylaws.

Nominee: _____________________________________
         
JCNA # __________________

has been a member of JCNA in good standing for 12 months or more, and by signature below certifies understanding of a Regional Director as set forth in Article VI and agrees to serve.

Nominee is currently a member of _________________________________, a JCNA affiliate, and is nominated to represent the ___________________      region.

(1)	This nomination is in the name of affiliate # ______  and bears the names, titles, JCNA numbers, and signatures of two of the affiliate’s officers.

Name ___________________
Title _______________________, JCNA # ___________

Signature 

Name ___________________
Title _______________________, JCNA # ___________

Signature 

or
(2)	This nomination is by an individual JCNA member.

Name ____________________________________
JCNA # _____________

Signature

(3)	I agree to serve if elected
(4)	
Signature of Nominee

SEND TO ARRIVE NOT LATER THAN AUGUST 1ST
TO: Gary Hagopian
NH: PO Box 410 Sunapee, NH 03782
NH: 603-763-3093 (H) 603-763-9931 (F)
Cell: 413-537-8427 

			Date submitted