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G i <br />In the space below, describe any special skills or attributes of nominee, which would enhance <br />his/her effectiveness as a member of the Triangle J Area Agency on Aging's Advisory Council <br />on Aging: <br />If not a self - nomination, please indicate the name, address and phone number of person or group <br />making nomination: <br />Name <br />Address <br />Phone Number (including area code) <br />r� <br />L <br />SIGNATURE OF NOMINEE Date: <br />(Note: The signature is required for self - nominations as well as for nd rinations made by other individuals or <br />groups. This signature of the nominee serves as verification that the person being nominated consents to his /her <br />name being placed in nomination and indicates a commitment on the part of the nominee to participate fully in the <br />orientation, training and work of the Advisory Council on Aging.) <br />SIGNATURE AND TITLE OF COUNTY REPRESENTATIVE INDICATING COUNTY <br />ENDORSEMENT OF NOMINEE <br />Date: <br />Return Form to: Joan Pellettier, Director, Area Agency on Aging <br />• Triangle J Council of Governments <br />PO Box 12276 <br />RTP, NC 27709 <br />(919) 558 -9398 f<1x: (919)549 -9390 <br />jpellettier @tjcog.org <br />