2016 National Delegates Assembly Credentials Committee Trekeshelia Britton, Chair
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- ALTERNATE DELEGATES FORM
PRIMARY DELEGATES FORMPlease complete all requested information. If not completed, you will be contacted for the required information. This form may be copied if additional names are submitted. Please return by FRIDAY, AUGUST 5, 2016. Submissions after this date must be brought On-Site at the NDA. Submit to Chair Trekeshelia Britton at trekeshelia.britton.gowh@statefarm.com, with copies to: Pinkie L. Mason via e-mail at pinkie.mason@att.netREGION #_________ (Region and Chapter Name - Required Information)CHAPTER NAME__________________________________________PLEASE MAKE SURE THE SPELLING OF DELEGATES’ NAME MATCHES WITH THE NATIONAL OFFICE SPELLING. THIS WILL ENSURE PROPER CREDENTIALING OF YOUR DELEGATES.
Chapter President _______________________________________ Signature President’s E-Mail Address (es) ____________________________________________________________ Appointee__________________________________________________ Signature Appointee’s E-Mail Address (es) ______________________________________________________ ATTACHMENT 2 ALTERNATE DELEGATES FORMPlease complete all requested information. If not completed, you will be contacted for the required information. This form may be copied if additional names are submitted. Please return by FRIDAY, AUGUST 5, 2016. Submissions after this date must be brought On-Site at the NDA. Submit to Chair Trekeshelia Britton at trekeshelia.britton.gowh@statefarm.com, with copies to: Pinkie L. Mason via e-mail at pinkie.mason@att.netREGION #_________ (Region and Chapter Name - Required Information)CHAPTER NAME__________________________________________PLEASE MAKE SURE THE SPELLING OF DELEGATES’ NAME MATCHES WITH THE NATIONAL OFFICE SPELLING. THIS WILL ENSURE PROPER CREDENTIALING OF YOUR DELEGATES.
Chapter President _______________________________________ Signature President’s E-Mail Address(es)____________________________________________________________ Appointee__________________________________________________ Signature Appointee’s E-Mail Address(es)______________________________________________________ ATTACHMENT 3 
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