Candidate Profile Form Page 3

Please sign below:

I attest to the fact that all information I have provided on this form is true to the best of my

knowledge. I am submitting my candidacy for the Self Help, Inc. Board of Directors election as

a limited income representative. I give permission for Self Help to develop a candidate profile

from the information I have provided with the exception of my place of residence and phone

number. I have marked with an X information that I do not want included in my profile.

Please sign and date: ___________________________________________________ _______

Please mail this form to: Carol Murray, Self Help, Inc., 142 Crescent St., Brockton, Ma. 02302.

0 votes

Parent category: Business