Office desired _____________________

Name ___________________________

Address _________________________

City _____________________________

State ____________________________

Zip Code _________________________

E-Mail Address ____________________

Names of members in support of your run for this office.

First & Last Name Date Signed

1. ___________________________________________________

2. ___________________________________________________

3. ___________________________________________________

4. ___________________________________________________

5. ___________________________________________________

6. ___________________________________________________

7. ___________________________________________________

8. ___________________________________________________

9. ___________________________________________________

10. _________________________________________________

You need five members in good standing. Please return this form to me by 06/01/07.

Thank you.

Judith (Judie) Welch - Secretary/Treasurer

1460 McGill Hollow Road

Linden, Pa. 17744-7722

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