AMA District 11 Proposal Submission Form

Submitted by:____________________________________   Date: _________________

Change or addition to:   Constitution______; Bylaws______; or Policy Guidelines________

Change or addition to: Article   ______________________________,   

                                    Section________   Number _________

State Reason for this proposal.   It is very important to explain in detail the reason for this change/addition.

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Write out the exact wording of proposal as it will read if accepted: ________________________________________________________________________________

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District Proposal Number ___________ ,           Meeting Date ____________________

                                                                          Accepted ____Yes _____No                  

                                                                                        Amended ____Yes, _____No                  

Original: D-11Secretary

Cc:   Proposal author

       D-11 Office

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