ARKANSAS HOSPITAL AUXILIARY ASSOCIATION STATE NOMINATION FORM

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For the Office of: President Elect ☐ Vice President ☐ Secretary ☐ Treasurer ☐ Newsletter Editor ☐ (Please check box)

Nominee’s Name: Click here to enter text. Mailing Address: Click here to enter text. E-Mail Address (required): Click here to enter text. Phone Number(s): Click here to enter text.

Name of Auxiliary: Click here to enter text. Name of Hospital: Click here to enter text. Auxiliary Member (Total number of years): Click here to enter text. Current District: Click here to enter text.

ELECTED OFFICES HELD IN AUXILIARY Position Local District State (Show the year or years in each position) President: Click here to enter text. Click here to enter text. Click here to enter text. Vice President: Click here to enter text. Click here to enter text. Click here to enter text. President Elect: Click here to enter text. Click here to enter text. Click here to enter text. Secretary: Click here to enter text. Click here to enter text. Click here to enter text. Treasurer: Click here to enter text. Click here to enter text. Click here to enter text. Newsletter Editor: Click here to enter text. Click here to enter text. Click here to enter text. District Chair: Click here to enter text. Click here to enter text. Click here to enter text.

APPOINTED OFFICES HELD IN AUXILIARY Position Local District State

Convention Chair: Click here to enter text. Click here to enter text. Click here to enter text. Legislative Chair: Click here to enter text. Click here to enter text. Click here to enter text. Committee Chair: Click here to enter text. Click here to enter text. Click here to enter text.

ADDITIONAL LEADERSHIP POSITIONS HELD (Please type or print in the space below) Click here to enter text. Click here to enter text. Click here to enter text.

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