*1.Contact info(Required.)

First name

Last name

Email

Phone

*2.Position(Required.)

ChairFirst Vice-ChairVice-Chair for RecruitmentVice-Chair for MembershipVice-Chair for PCOsVice-Chair for ProgramVice-Chair for EventsVice-Chair for CommunicationsVice-Chair for TechnologySecretaryTreasurerState Committee delegate (woman)State Committee delegate (man)County Committee delegate (woman)County Committee delegate (man)County Committee alternate (woman)County Committee alternate (man)

3.Candidate statement (optional)

4.Social media profile(s) (optional)

Facebook

Instagram

LinkedIn

Twitter

5.Preferred source of headshot (optional)

FacebookInstagramLinkedInTwitterNo headshot