Candidate Information Statement For Open State Seats
NARP Candidate Information Statement For Those Seeking Appointment To An Open State Representative Seat On The Council of Representatives
Please complete and submit this form if you wish to be considered for appointment by the Board of Directors
to an open state representative position.

There is NO deadline to apply; submissions will be reviewed and considered on a rolling basis.

Your Full Name (First, Middle Initial, Last)
Your answer
You Are Seeking To Be Appointed As A State Representative For The State Of:
Your answer
Your State Of Permanent Legal Residence
Your answer
Are You A Registered Voter At Your Permanent Legal Address:
Required
Your Primary Mailing Address: (#, Street, Apt. #, PO Box #, etc.)
Your answer
Your Primary Mailing Address: (City, State And Zip Code)
Your answer
Your Primary Phone Number: (the number you regularly receive phone calls at)
Your answer
Your Primary Phone Number Is:
Your Secondary Phone Number: (if applicable)
Your answer
Your Secondary Phone Number Is:
Your Primary E-Mail Address: (the e-mail address which you regularly use to send and receive messages with)
Your answer
Alternate Contact Information: (if applicable)
Your answer
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