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NATIONAL <br />NAC <br />ASSOCIATION <br />(COUNTIES <br />2018 <br />CREDENTIALS <br />VOTINGFO R M <br />PLEASE TYPE OR PRINT IN BLOCK LETTERS. <br />Please complete and <br />RETURN FORM BY <br />JUNE 29, 2018 to: <br />Credentials Committee / NACo <br />Attn: Alex Koroknay-Palicz <br />660 North Capitol St, NW, <br />Suite 400 <br />Washington, DC 20001 <br />You may also fax this form to: <br />666370.9421... or scan and e-mail <br />this form to: akpafi z@Lmco.org ... <br />or have the voting delegate(s) carry <br />it with him/her to the NACo <br />conference and present it at the <br />Credentials Desk. <br />If you do not plan on registering for the <br />2018 Annual Conference, there is no <br />reed to fill out arW Mum this form. <br />Your county/parish/borough MUST <br />have at least one paid conference <br />registration to be able to vote. <br />By signing this form you are declaring <br />that you and the other conference <br />attendees from your county have <br />agreed that you are the voting delegate <br />for your county. <br />If your ballot is not picked up at <br />the 2018 Annual conference the <br />President of your State Association <br />will pick up and cast your county's <br />votes unless you check the box <br />below. <br />If my ballot is not picked up, <br />1 DO NOTAUTIIORIZE my <br />state association to pick up or cast <br />my county's vote. I understand that <br />my county's votes will NOT be cast <br />if I select this option. <br />County/ Parish/ Borough State <br />111111111111 111111 11111 m <br />Name your county / parish /borough's delegate (s) <br />Designated County Delegate <br />First Name last Name <br />Job Title / Description <br />County Alternate <br />First Name Last Name <br />Job Title / Description <br />Please note: This form must be signed by the CHIEF ELECTED OFFICIAL from your county. <br />Submissions without an appropriate signature will not be accepted <br />Signature of Chief Elected Official Date Cell Number <br />(Basel President/ Chair/ elected County Executive / Judge / Mawr) <br />Print Name Title <br />\n <br />G-6 Page 446 <br />