Candidate Information Form (National)

AMERICAN MENSA NATIONAL NOMINATING COMMITTEE

CANDIDATE INFORMATION FORM

For Nominating Committee use only

To: NomComm

I am a candidate for nomination for the position shown in the forthcoming Mensa election.

Name:

Position Sought:

Address:

E-mail address:

Region:

Local Group:

Phone:

Mensa Member #

Year Joined:

Incumbent in this position: ___yes ____no

Present and previous elected or appointed National or Regional offices held in Mensa and how long served:

Present and previous elected or appointed Local offices held in Mensa and how long served:

How do you view the present needs of the position you seek, and how do you plan to meet them?

How do you view the future needs of the position you seek, and how do you plan to meet them?

What plans and suggestions do you have for the betterment of Mensa?

Additional comments:

If nominated, I agree to run. If elected, I agree to serve.

Signed Date

(E-mailed forms may substitute typed name for signature)

Please return completed forms no later than July 31, 2000 to:

Cher Burnham, NomComm ChairM

104 Brassel St

Lockport IL 60441

cherburnham@juno.com