<Honor Society Name>
Candidate Consent Form

I understand that my name has been placed on the (insert honor society name) ballot for the office/committee of (insert position/committee title), and, if elected, I will accept the position and fulfill the responsibilities of this office/committee.

Signature: 	

Date: 	

Name and Credentials: 	                                                                                                    

Home Address: 	                                                                                                                

Home Phone: 	                                                                                                                   

Business Title: 	                                                                                                                  

Business Address: 	                                                                                                             

 
Business Phone: 		FAX Number: 	                                         

Email Address: 	                                                                                                                

I prefer that mail be sent to my     home    office

Please return this form by (insert due date) to:
(insert name, address, phone, fax, email of person collecting form)