<p> ARKANSAS HOSPITAL AUXILIARY ASSOCIATION STATE NOMINATION FORM</p><p>(Please type or print)</p><p>For the Office of: President Elect ☐ Vice President ☐ Secretary ☐ Treasurer ☐ Newsletter Editor ☐ (Please check box)</p><p>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.</p><p>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.</p><p>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.</p><p>APPOINTED OFFICES HELD IN AUXILIARY Position Local District State</p><p>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.</p><p>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.</p><p>2017 Page 1 of 2</p>