2010 Delegate Report Form

Delegate Assembly will be held April 16-17, 2010, at the Cornhusker Marriott Hotel in Lincoln.

Use the form below to report your delegate(s) for the 2010 Delegate Assembly.

For names to be included in the 2010 Delegate workbook and roster, they must be received by March 31, 2010.

Local Association:*

Submitted by:*

Local President

Your email:*

NSEA District:

select one

Capitol
Elkhorn
Higher Education Academy
Metro
Panhandle
Sandhills
Tri Valley

Number of Delegates:

Delegate #1:

(Name, Address, City, Zip)

Delegate #1 email:

Delegate #2:

(Name, Address, City, Zip)

Delegate #2 email:

Delegate #3:

(Name, Address, City, Zip)

Delegate #3 email:

Delegate #4:

(Name, Address, City, Zip)

Delegate #4 email:

Delegate #5:

(Name, Address, City, Zip)

Delegate #5 email:

Delegate #6:

Delegate #6 email:

Alternate:

(Name, Address, City, Zip)

Alternate #1 email:

Alternate:

(Name, Address, City, Zip)

Alternate #2 email:

Date:

By clicking SUBMIT, you affirm that the above named delegate(s) have been selected to represent your local association at the 2010 Delegate Assembly.

Confirmation Code:

Enter the code shown in the box before clicking on submit.

Note: Fields marked by an asterisk (*) are required.

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2010 Delegate Report Form