MY27 Service Unit Delegate Election Form
Service Unit Number
*
Service Unit Name, if applicable
Submitted by
*
Date of Election
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Submitted
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Delegate voted in by the Service Unit
*
First Name
Last Name
Delegate's Email
*
example@example.com
Delegate's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Delegate voted in by Service Unit (if applicable)
First Name
Last Name
Delegate's Email
example@example.com
Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Delegate voted in by Service Unit (if applicable)
First Name
Last Name
Delegate's Email
example@example.com
Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Delegate voted in by Service Unit (if applicable)
First Name
Last Name
Delegate's Email
example@example.com
Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Alternate Delegate voted in by the Service Unit
First Name
Last Name
Alternate Delegate's Email
example@example.com
Alternate Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Alternate Delegate voted in by the Service Unit
First Name
Last Name
Alternate Delegate's Email
example@example.com
Alternate Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Delegate voted in by Service Unit (if applicable)
First Name
Last Name
Alternate Delegate's Email
example@example.com
Alternate Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of additional Alternate Delegate voted in by the Service Unit
First Name
Last Name
Alternate Delegate's Email
example@example.com
Alternate Delegate's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I certify that my Service Unit held an open election according to the Bylaws of GSHPA and these are the results.
*
Yes
Name of Service Unit Lead
*
Today's Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please verify that you are human
*
Submit
Should be Empty: