CANDIDATE
WISCONSIN 2000-2001 STATE DELEGATE
TO THE NEA REPRESENTATIVE ASSEMBLIES
THIS FORM MUST BE SUBMITTED TO:
EXECUTIVE DIRECTOR
WISCONSIN EDUCATION ASSOCIATION COUNCIL
33 NOB HILL DRIVE
P.O. BOX 8003
MADISON, WI 53708
MUST BE POSTMARKED BY: JANUARY 5, 2000
NAME OF CANDIDATE: _________________________________________________
(please print)
SOCIAL SECURITY # _______ - ____- ________
ADDRESS: (street)_______________________________________________________
(city) ___________________________ (state) __________________ (zip) ___________
PHONE: (School) ________________________ (Home) _________________________
IF ELECTED, I SHALL BE WILLING TO SERVE IN THE POST OF NEA DELEGATE TO THE 2000 NEA REPRESENTATIVE ASSEMBLY IN CHICAGO, ILLINOIS, AND THE 2001 NEA REPRESENTATIVE ASSEMBLY IN LOS ANGELES, CALIFORNIA.
IF ELECTED AS BOTH A STATE AND LOCAL DELEGATE, I WILL CHOOSE TO SERVE AS A STATE [ ] LOCAL [ ] DELEGATE.
I UNDERSTAND THAT NO PORTION OF DUES MONEY COLLECTED AT THE LOCAL, REGIONAL, STATE, OR NATIONAL LEVEL MAY BE USED TO PROMOTE MY CANDIDACY FOR NEA DELEGATE.
____________________________
(signature of candidate)