WASHINGTON STATE SOCIETY OF MEDICAL ASSISTANTS

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					        WASHINGTON STATE SOCIETY OF MEDICAL
                    ASSISTANTS
    NOMINATION FORM (submit no later than 90 days before annual meeting)
    And Application for Members at Large to WSSMA HOD (submit by Feb 13th)

The following WSSMA leadership positions are open for nominations:

PRESIDENT
VICE-PRESIDENT                  SPEAKER OF THE HOUSE
TREASURER                       VICE-SPEAKER OF THE HOUSE
TRUSTEE (3)                     NOMINATIONS COMMITTEE (3)
DELEGATE/ALTERNATE DELEGATES TO AAMA CONVENTION (4)


Please fill out the following information and return to the nominations chair.

I offer my name in the nomination for the position of ________________________.
I offer my name to be appointed to represent Members at Large at the HOD __________.

I am a member in good standing in the______________ chapter and have served on the
following:

Component Chapter:_______________________________________________________
________________________________________________________________________
________________________________________________________________________

State Society:____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

AAMA:_________________________________________________________________
________________________________________________________________________


 Records of the _________________________________________Chapter/ State Society
certify that _____________________________________________________is a member
in good standing and has served as stated above.
                   Chapter/State President: ____________________________________

I hereby certify my willingness to accept the nomination for the position of
_____________________________________. I will do my best to serve in this capacity
if elected/ appointed

____________________________________________________ ________________
Signature of Nominee/Member at Large                  Date



Revised 11/08kj