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Petition for Nominating an Academy Member to Stand as a Candidate for Regular Director on the Academy Board of Directors TO:

Chairperson and Members 2012 American Academy of Actuaries Nominating Committee

RE:

Nomination of _________________________________________________________ To Stand as a Candidate for Regular Director on the Academy Board of Directors

DATE: ___________________________________

We the undersigned members of the American Academy of Actuaries hereby nominate the following member to be stand as a candidate for Regular Director on the Academy Board of Directors. Candidate Name (please print/type name)

Candidate Signature

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We further nominate the above-named Academy member to be placed on the ballot for the following open Regular Director position on the Academy Board of Directors (select one): … Class of 2015/Health … Class of 2015/Health … Class of 2015/Open Practice Area Petitioners Petitioner’s Name (Please print/type)

Petitioner’s Signature

Petitioner’s Employer

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2012 Nominating Petition

Petitioners Petitioner’s Name (Please print/type)

Petitioner’s Signature

Petitioner’s Employer

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2012 Nominating Petition

Petitioners Petitioner’s Name (Please print/type)

Petitioner’s Signature

Petitioner’s Employer

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2012 Nominating Petition

NOTES: Petition for Nominating an Academy Member to Stand as a Candidate for Regular Director on the Academy Board of Directors • • •

• • • • • • • • •

All candidate petitions must be accompanied by a completed and signed Candidate Statement form. Only one candidate seeking nomination to stand as a Candidate for Regular Director on the Academy Board of Directors per petition. Candidates for Regular Director on the Academy Board of Directors cannot be under investigation by the Actuarial Board for Counseling and Discipline (ABCD) or any other disciplinary authority. Candidates for Regular Director on the Academy Board of Directors cannot have been publicly or privately disciplined by any actuarial organization. Minimum number of signatures of Academy members required for petition to be considered by Nominating Committee: 50. Minimum number of employers petition signers must represent for petition to be considered by Nominating Committee: 5. All petition signers must be members of the Academy, including but not limited to dues for the current year being paid in full, as of the date of this petition. To be valid, this petition must be received by the Nominating Committee at the offices of the American Academy of Actuaries before 5:00 pm on April 27, 2012. For purposes of meeting the above deadline, properly executed forms may be transmitted to the Nominating Committee at the offices of the American Academy of Actuaries via mail, facsimile, or email before 5:00 pm on April 27, 2012. Original signatures will be accepted on forms; facsimile or digital signatures will be accepted, subject to verification by the Academy. Multiple copies of this form may be executed and submitted in support of the candidacy of one Academy member. All fields (printed name, signature, name of employer, verification of Academy membership) must be completely and legibly completed for a petitioner’s signature to be counted toward the required 50 signatures from members representing a minimum of 5 employers. Contact information for the Nominating Committee of the American Academy of Actuaries: 1850 M St. NW Suite 300 Washington, DC 20036 FAX: 202.872.1948

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Nomination Petition Form_Regular Director_2012_WM  

Petition for Nominating an Academy Member to Stand as a Candidate for Regular Director on the Academy Board of Directors TO: Chairperson and...

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