Officer Election Form

TEXAS SOCIETY OF MEDICAL ASSISTANTS OFFICER NOMINATION CONSENT FORM FOR TERM

*are Required Fields

I, *

hereby give my consent to have my name placed on the ballot for the office of *

of the Texas Society of Medical Assistants. I do acknowledge that I have read the TSMA By-Laws and understand what my duties will be if elected into the above named position. I will do my best to serve in the capacity if elected.

Your Typed name will be considered as your signature *

Today's Date

Phone

Biographical Data: Please list any current/previous activities (include year and position) that demonstrate leadership ability.

State Society

AAMA or Other Activities

Local Chapter *

*ALL FORMS MUST BE SUBMITTED TO THE NOMINATIONS COMMITTEE BY NOON THE DAY OF PRE-CONFERENCE MEETING.

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TEXAS SOCIETY OF MEDICAL ASSISTANTS OFFICER NOMINATION CONSENT FORM FOR TERM