NCSRC - Official Nomination Form

As an Active or Life member of the NCSRC, Inc. I have reviewed the CRITERIA FOR CANDIDATE NOMINATION and submit the members listed below for consideration as candidates. I understand that I do not need their permission and that their membership status and eligibility shall be verified in accordance with established criteria.

CATEGORY

NAME OF MEMBER and MAILING ADDRESS

President-Elect:

Vice President:

Secretary:

Treasurer:

Board of Directors:

Delegate:

Your Name:

AARC Membership #

or mail to:

NCSRC CENTRAL OFFICE
PO Box 1795
Morehead City, NC 28557

FORM MUST BE RECEIVED BY NOMINATION COMMITTEE BY: April 15, 2010