2018-2019 Election Registration Form

LICSPA Elections will be held on Tuesday, January 9, 2018 at Adelphi University. LICSPA election registration is now open and professionals who are interested in running for office should complete this form by Thursday, January 4, 2018.

For more information on LICSPA, visit us at www.licspa.net

Candidate Information

First Name: *

Last Name: *

Institution: *

Title/Department: *

Years of Experience: *

Email: *

Phone (xxx-xxx-xxxx) *

LICSPA Information

What position are you running for? *

How many LICSPA Conferences have you attended? *

How many LICSPA Meetings have you attended this year? *

Election Registration Form Due: Thursday, January 4