Sigma Theta Tau International
Chapter Candidate Consent Form

I understand that my name has been placed on the Mu Phi At Large Chapter ballot for the office/committee of  _________________, and, if elected, I will accept the position and fulfill the responsibilities of this office/committee.

Signature: 	 
                  (Typed name will be considered your signature)

Date: 	

Name and Credentials: 	                                                                                                    

Home Address: 	                                                                                                                

Home Phone: 	                                                                                                                   

Business Title: 	                                                                                                                  

Business Address: 	                                                                                                             

 
Business Phone: 		FAX Number: 	                                         

Email Address: 	                                                                                                                

I prefer that mail be sent to my     home    office

Please return this form by 3/31/2020 to:
Nancy Ballard via email at  nballard@kennesaw.edu.