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38553 <br /> <br />NACo 003 Credentials (Voting) <br /> <br />Identification Form <br /> <br />Please complete and return this form bv Juqe 20th to: <br />NACo, Attn: Emily Landsman,!440 First Street, NW, Wasl~ngton, DC 20001 <br />or fax it to Emily Landsman, ai (202) 393-2630 by June 20th <br />or have the voting delegate(s)icarry it with them to the conference and present it at the <br />Credentials Desk. <br /> County/Parish/Borough <br /> <br />Designated Delegate <br />First Name <br /> <br />Last Name <br /> <br />State <br /> <br />Job Title <br /> <br />First Alternate <br />First Name <br /> <br />Last Name <br /> <br />Job ~fle <br /> <br />Second Alternate <br />First Name <br /> <br />Last Name <br /> <br />Job <br /> <br /> This form must be signed by ~he Chief Elected Official from your county. Submissions <br /> without an appropriate sig ,r~ature will not be accepted. <br /> Signature: <br /> Board PresidentJCh~lirmanlJudge/Mayor Signature Required Date <br /> <br />E~ Check here if you do not ~ish the State Association Representative to pick up your credentials <br /> and vote on your behalf i~ lieu of your county/parish/borough voting. <br /> <br /> [-"J Check here if you wish tolvote by proxy. If checked, list the county/parish/borough to cast your <br /> votes below. The proxy r~ust have at least one paid registrant for NACo's Annual Conference. <br /> County/Parlsh/Boroughallowe~l to cast my votes <br /> <br /> <br />