Consent to be Nominated
for
_____________ County Extension Council
I,__________________________________________, agree to have my name submitted in
nomination as a member of the ______________________County Extension Council.
The election for _____________________ Extension Council is _____________________.
If elected, I agree to serve.
Name: _____________________________
Address: ___________________________
Phone: ____________________________
E-mail: ____________________________
Commissioner District: ________________
Signature: _____________________________________
Date: _________________________________________
Kansas State University Agricultural Experiment Station and Cooperative Extension Service
K-State Research and Extension is an equal opportunity provider and employer.
8/08