» Candidate Statement Information Form

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Name: *

Position Sought: * State Representative At-Large Representative
Note: Applications are only being accepted for State and At-Large Representative at this time. State Representatives will be elected by the general membership in January, and At-Large Representatives will be elected by the Council of Representatives in April. We will begin accepting applications for Officers and Directors, who will be elected by the Council of Representatives at its April meeting, in February.

Are you a registered voter? * Yes No

State of permanent residence: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Visions and Goals

Your Vision for Rail Passenger Advocacy:

Your goals for NARP if elected or appointed to this position:

Other than attending regular meetings, how much time are you willing to devote to NARP’s advocacy work (hours per week or days per month)?

What types of activities would you be most interested in and willing to do?
Examples include: communicate with NARP members, recruit new members, fundraising, distribute leaflets, brochures and other materials, meet with elected officials, make presentations to local groups, organize events and petition drives, write articles and letters to the editor, provide technical advice on Internet communications, research and write white papers.
See the Position Description for State Representative for other possibilities.

Professional Data (may include Military Service):
Indicate Organization/Firm/Positions held/Dates/Duties and Activities for each

Education:
Indicate Institutions/Organizations/Degrees/Certifications/Fields of Study

Organizational Affiliations:
Include professional, advocacy, civic/governmental and religious organizations (including elected office), and any leadership positions

Significant Life Achievements:

Other Areas of Expertise and Talents:

Remarks:
Any Additional Information you feel is relevant to your candidacy

*NON-INCUMBENTS ONLY*: Please list three references and their daytime telephone numbers:

I affirm that all the information contained within this Statement is both true and correct.

Electronic Signature of Candidate (type name): *

Date (mm/dd/yyyy): *

Candidate Personal Data

Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Home Phone:

Office Phone:

Cell Phone:

Fax:

Fax Connection: On 24/7 Call First

Email:

Other (e.g. winter/summer home):

INCUMBENT STATE REPRESENTATIVES SEEKING RE-ELECTION ONLY: Please check the box beside each Council meeting that you, or your Alternate, attended: Spring 2008 (Washington, DC)
Fall 2008 (Portland, OR)
Spring 2009 (Washington, DC)
Fall 2009 (St. Louis, MO)
Spring 2010 (Alexandria, VA)
Fall 2010 (Grand Rapids, MI)
Spring 2011 (Alexandria, VA)
Fall 2011 (Los Angeles, CA)