2008 Nominee for Jurisdictional Pool

* required information
 
Nominee Information
Please complete the form below for each nominee.
Title:
First Name:*
Last Name:*
Suffix:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Fax:
Email:*
Occupation:*
Jurisdiction:*
Annual Conference:*
First Choice Nominee Pool:*
Second Choice Nominee Pool:*
Third Choice Nominee Pool:*
Job Role:*
Ethnicity:* Asian American
African American
Hispanic American
Native American
Pacific Islander
White
Other
Age Group:* Youth (12-16)
Young Adult (17-28)
Adult (29-64)
Older Adult (65 and older)
Person with a disability:* Yes
No
Delegate to the 2008 General Conference:* Yes
No