DignityUSA Nomination Form

Your Identification

First Name *

Last Name *

Street Address

Street Address Line 2

City *

State/Province *

Postal Code

Home Number *

Cell Number

Email *

Your Picture *

Send a JPEG, quality head and shoulders photo of yourself to accompany your candidate statement. Use your photo-editing software to reduce the size to no greater than_____.

Position *

President

Vice President

Director

Slate partner

If nominating for president or vice-president, please enter slate partner's name.

Background

Educational Background

Professional Background

Volunteer Service

Candidate Statement *

The following narrative will be used to inform the voters why you seek to serve in this capacity and what you intend to contribute to the governance and welfare of DignityUSA. Statements are subject to grammatical and format editing by the Elections Committee. In 300 words or less, address the following points: 1. What is the importance of Dignity? 2. How have you served in the past? 3. What skills and experience can you bring? 4. What is your vision for the future? What priorities do you see?

Vision Statement

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