Forms for Districts

Pennsylvania Association of Conservation Districts, Inc.
Voting Delegate Designation Form

Download this form in Word | PDF

Conservation District: ___________________________________

Please indicate your district's Voting Delegate and up to three Alternate Voting Delegates in descending order of preference.

Voting Delegate
___ Director ___ Associate Director ___ Staff (Please Check One)

Name: ________________________________________________

Address: ______________________________________________

Phone:____________________ e-mail: ______________________

Alternate Voting Delegate #1
___ Director ___ Associate Director ___ Staff (Please Check One)

Name: ________________________________________________

Address: ______________________________________________

Phone:____________________ e-mail: ______________________

Alternate Voting Delegate #2
___ Director ___ Associate Director ___ Staff (Please Check One)

Name: ________________________________________________

Address: ______________________________________________

Phone:____________________ e-mail: ______________________

Alternate Voting Delegate #3
___ Director ___ Associate Director ___ Staff (Please Check One)

Name: ________________________________________________

Address: ______________________________________________

Phone:____________________ e-mail: ______________________

IMPORTANT: This form is valid only when signed by the District Chairman. No other may sign in his/her place.

______________________________________ _______________
Signature of District Chairman                                Date

Please return this form to:
PACD
25 North Front Street
Harrisburg, PA 17101
Fax: (717) 238-7201

Questions? Call PACD at (717) 238-7223