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LWVPBC State Delegate Application
Please complete each question of the form below and click "submit" on the bottom of the page to be considered to represent the LWVPBC at the State Convention on June 5-6, 2021.
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First Name
*
Your answer
Last Name
*
Your answer
Best Phone Number
*
Your answer
Type of Phone
*
Choose
Cell Phone
Home Phone
Work Phone
Second Phone Number (Please enter "N/A" if you do not have a second number.)
Your answer
Type of Phone
Choose
Cell Phone
Home Phone
Work Phone
Email Address
*
Your answer
Number of Years as a League Member
*
Your answer
League Committees Participated On
*
Your answer
Special Interests to be Considered for Placement during Sessions
*
Your answer
I am available for the virtual Delegates meeting on May, 27th at 6:30pm.
*
Yes
No
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