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AS SOCI AT ION G OV ER NA NCE National Education Association (NEA) 2014 Representative Assembly Statewide, Regional, or Retired Delegate Nomination Form For nomination of self or another Arizona Education Association/National Education Association Active, Life or NEA-Retired member to the NEA Representative Assembly Nomination Form must be submitted to the Arizona Education Association headquarters on or before 5 PM, January 10, 2014. Nomination Forms submitted after 5 PM on January 10, 2014, will not be accepted. Candidate _ _____________________________________________________________________________________________ Address ___________________________________________ City ____________________ State _____ ZIP _________ Local Association ____________________________________ Home Email ______________________________________ Telephone (H) _____________________________________________ (W) ______________________________________ Candidate for the office of: NEA • Statewide Delegate • Term: One Year NEA • Regional Delegate • Election District _______• Term: One Year NEA-Retired • NEA-Retired Delegate • Term: One Year SEE ELECTION DISTRICTS, PAGE 27 Candidates for National Education Association Statewide, Regional, or Retired Delegates may submit a statement NOT TO EXCEED THE 50-WORD LIMIT to be distributed to eligible voters. Please attach the candidate statement to this form. In all campaign statements, the articles "a," "an," "to," and "NEA," "AEA," and the local association name or abbreviation shall be counted as a single word. Campaign statements that exceed appropriate limitations will be cut by striking complete sentences from the end of the statement until the statement meets the word limit. The Arizona Education Association candidates for Statewide, Regional, or Retired Delegates may provide a current photo, if it is to be published with their statement. Photos will not be returned. The Arizona Education Association does not maintain a photo file from year to year. The undersigned has read and approved the attached statements about the candidate. ––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––– Signature of Nominator (Optional) Signature of Candidate (Candidate must sign) Nomination form and statement must be submitted on or before 5 PM on January 10, 2014. NOMINATION FORM MAY BE SUBMITTED VIA MAIL, HAND-DELIVERY, FAX, OR EMAIL TO: AEA Elections Committee, 345 E. Palm Lane, Phoenix, AZ 85004 FAX: (602) 240-6887 • Email: chris.mayer@arizonaea.org 28 Winter 2013/14 x AEA Advocate Winter.13advo.indd 28 11/4/13 3:23 PM