Membership Ballot Confirmation Form
Please confirm your membership ballot details and eligibility below. All information will be used solely for ballot confirmation purposes.
Full Name
*
First Name
Last Name
Membership ID
*
Email Address
*
example@example.com
Ballot Reference Code
*
Are you currently an eligible member in good standing?
*
Yes
No
Please confirm the following statement: I am submitting this ballot as an eligible member and all provided details are accurate.
*
I confirm
Signature (Type your name or use your mouse/finger to sign)
*
Submit Ballot Confirmation
Submit Ballot Confirmation
Should be Empty: