Date:____________________________

To the Secretary:

As primary sponsor, I hereby propose as a Candidate for Active Membership in the American Clinical and Climatological Association (please type or print)

Candidate's Name:_____________________________________________________  Date of Birth:___________________ 

Spouse's Name:_______________________________________________________________________________________

 

Place of Employment:__________________________________________________________________________________

Address:_____________________________________________________________________________________________
              

               _____________________________________________________________________________________________

 

Candidate's Phone:_______________________  Fax:__________________________ Email: ________________________

 

The two secondary sponsors will be      (1)__________________________________________________________________

 

                                                                 (2)__________________________________________________________________

My letter as primary sponsor is enclosed.  The secondary sponsors have agreed to submit to the Secretary their letters endorsing this candidate.  We understand that these letters will be considered confidential.

 

         ___________________________________________________          _____________________________________________                          

                                         Primary Sponsor (Print)                                                          Primary Sponsor (Signature)

 

Conditions and Comments:

 

1.  A current Curriculum Vitae and Bibliography of the candidate are required

     for this proposal to be complete.

2.  The primary sponsor's letter is required and must accompany this

     proposal.

3.  Candidates must be willing to be active members for at least seven years

     after election.

4.  The following are recommended by Council:

       a.    Secondary sponsors from other than the candidate's home city strengthen the

              proposal.

       b.    Additional letters of support from the membership-at-large strengthen the Proposal

              and may be received any time prior to October 1st.

5.  It is the responsibility of the primary sponsor to ensure the letters of the secondary

     sponsors are received prior to the published deadline of June 15th. THEIR ABSENCE OR

     ABSENCE OF THE PROPOSAL FORM OR THE CANDIDATE'S CURRICULUM VITAE

     AND BIBLIOGRAPHY WILL PRECLUDE PROCESSING OF THE PROPOSAL