Convention Delegate Credential Form

Please complete the information below for each Delegate/Alternate elected to the convention.

The undersigned officers of Local #:

who can be contacted at this email address:

Please provide the email address where you would like to receive a copy of this form.

hereby certify that:

whose mailing address is:

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

whose cell phone is:

whose personal email is:

is a member in good standing and a duly elected:

Delegate

Alternate

of Local #:

to the Washington Federation of State Employees' 51th Biennial Convention held at the DoubleTree Hotel located at 18740 International Blvd, SeaTac, WA. The Convention will convene at 1:00pm on Friday, October 3, 2025.

Local President Signature

Sign above

Signer Name

Signer Title

Local Secretary Signature

Sign above

Signer Name

Signer Title