DECLARATION OF INTENT FORM

2008 ELECTIONS COMMISSION (ECOM 2008)

LIBERIAN COMMUNITY ASSOCIATION (LCA) WASHINGTON, D.C. METROPOLITAN AREA

 

DEADLINE FOR SUBMISSION: FEBRUARY 17, 2008

 

1.      NAME: __________________________________________________________________________

 

2.      CURRENT ADDRESS:   _____________________________________________________________

                                                 _____________________________________________________________

 

3.      PREVIOUS ADDRESS:    ____________________________________________________________

                                                   ____________________________________________________________

                                                                        (if less than 12 months at current address)

4.      TELEPHONE #(s): (H)___________________________     (C )     ____________________________

 

5.      POSITION DESIRED:  ______________________________________________________________

 

6.      LENGTH OF LCA MEMBERSHIP: FROM ___________________  TO     _____________________

 

7.            PREVIOUS AND/OR CURRENT POSITION(S) HELD IN LCA OR ANY ORGANIZATION:

         _________________________________________________________________________________

         _________________________________________________________________________________

                                                                                                                                                                          

8.            REASONS FOR SEEKING POSITION AND INTENT OF SERVICE (GOAL, PURPOSE, ETC.)

         _________________________________________________________________________________

         _________________________________________________________________________________

         _________________________________________________________________________________

         _________________________________________________________________________________

 

I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED HEREIN ARE CORRECT AND CONSENT THAT THE ECOM MAY VERIFY ANY AND ALL INFORMATION PROVIDED.  I AGREE TO THE DISQUALIFICATION OF MY CANDIDACY IF ANY INFORMATION IS FALSE.

 

____________________________________ ________________                                                _________________________

CANDIDATE’S SIGNATURE                                                                                                                                               DATE

 

NECESSARY ATTACHMENTS: (PLEASE CHECK AS IS APPLICABLE TO YOUR CANDIDACY)

PRESIDENT:                 ____$100 NON-REFUNDABLE MONEY ORDER              ____ 100 NAMES & SIGNATURES LIST

VICE PRESIDENT:       ____$75 NON-REFUNDABLE MONEY ORDER                ____ 50 NAMES & SIGNATURES LIST

ALL OTHERS:              ____$50 NON-REFUNDABLE MONEY ORDER                ____ 50 NAMES & SIGNATURES LIST

 

ALL REQUIREMENTS MUST BE HAND DELIVERD OR MAILED (CERTIFIED WITH RETURN RECEIPT) TO CHAIRMAN ELECTIONS COMMISSION, ISAAC VAH TUKPAH, JR., 10915 MELWOOD PARK PLACE, UPPER MARLBORO, MD 20772 .  TO CONTACT CHAIRMAN, ECOM, PLEASE CALL 202-341-8930 OR EMAIL ITUKPAH@KENDEJAH.COM.