WEAC-R Delegate to WEAC RA Candidate Nomination Form – Wisconsin WEAC Region 10/Retired Delegate to the WEAC Representative Assembly Candidate - Wisconsin 2018 Retired Delegate to the WEAC Representative Assembly If you are human, leave this field blank. This form must be submitted by January 12, 2018. Name of Candidate Membership ID (Do NOT use Social Security Number. If Membership ID is not known, please contact WEAC Membership at 800-362-8034 x 507). Street Address City State Zip Code Home/Cell Phone Home Email Address Candidate Bio Information (not to exceed 75 words). If elected, I am willing to serve as a WEAC Region 10/Retired delegate to the WEAC Representative Assembly, April 28, 2018, in La Crosse, Wisconsin.I understand that no portion of dues money collected at the local, state, or national level may be used to promote my candidacy for WEAC Region 10/Retired delegate to the 2018 WEAC RA.Please enter your name in the box below, which will serve as your signature. Signature Name, address, and phone number of nominator (if other than the candidate).