This application may be used by MDAA members wishing to be considered for appointment as a delegate to the ADAA Annual Conference if an opening remains or becomes available following the election of Delegates in any given year.
Qualifications:
¨ All nominees must be an active, special or life member of ADAA and MDAA.
¨ Shall have served as a local or state officer or standing committee member within the last five years.
¨ If the nominee was elected and served as a delegate the previous year, they must have submitted a written report to the President within 30 days of the end of the ADAA Annual Conference.
¨ If the nominee was elected and served as a delegate the previous year, they must have submitted receipts and a written expense report to the Treasurer to verify expenses for the allotment within 30 days of the end of the ADAA Annual Conference.
Name with Credentials (if applicable)_________________________________________
Address_______________________________City______________Zip_____________
Home Phone___________________________Work Phone________________________
ADAA membership Number____________________
Did you serve as a Delegate to the ADAA Annual Conference the year before?________
If so, did you submit the required report and expenses report and receipts by the date designated by the MDAA President?______________
Signature____________________________________Date________________________
Standing Rule:
All delegates and alternates must attend all meetings scheduled to prepare for the ADAA Annual Conference or forfeit their privilege of representing MDAA, the only exception being an excused absence given by the President due to an emergency. If a delegate / alternate does not commit to attend the ADAA Annual Conference at least two (2) weeks prior to the pre-registration deadline date, they will forfeit their position and be placed a the end of the lest regardless of plurality vote. Resignations should be submitted in writing to the President.
PLEASE COMPLETE THIS FORM IN ITS ENTIRITY AND SUBMIT IT TO THE MDAA PRESIDENT:
Barbara Gurnee CDA, R.D.A., FADAA, BS
4438 Two Mile Road
Bay City, MI 48706
email: bgurnee9896@charter.net