Candidate for Supreme 4th VP Form

This form is to be printed out and Completed by the  Candidate  Please refer to the instructions below
PHOTE HERE

___________________________

Candidate for the Office of Supreme 4th
Vice President at the 2008 Convention in
Reno, NV

Member of_________________

Club No. _________

Joined _________

Emblem Offices Held:

Club

State Association

Supreme

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emblem Profile

 

 

 

 

 

 

 

Personal & Professional Profile

 

 

 

 

 

 

 

 

 

 

Information on this form is to be typewritten. Please note on reverse side of this form if you wish a specific color, art work, and one or two song choices. Each Candidate Web Page will be different. Refer any questions to

PSP Terri Ferriera     Email: terriferreira@aol.com
Submitted by: ______________________________________________________
Candidates Name or Club Number & State

Name ______________________________________________________________

Address ____________________________________________________________

City _________________________ State __________________ Zip ___________

Phone _____________________________ Fax ____________________________

E-mail _______________________________________________________

Make Checks Payable to:  Supreme Emblem Club in the amount of $80.00 your canceled check will be your receipt.  Mall form along with your check to:

Judy Lyon
2515 Mt. Vista Rd.
Centralia, WA 98531    email   lyonjag@comcast.net