Constituency 2023 Registration Constituency 2023 First name * Last name * Email * Phone Address Address Street Address Street Address Address Line 2 Address Line 2 City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Constituency Meeting Attendance Are you planning to attend the 2023 constituency meeting? * Yes No Remember that if you are not able to attend, you may choose a proxy from the membership list below to vote in your stead. I am not able to attend the 2023 constituency meeting, and the person below has agreed that he/she will act as my proxy. He/she will cast a vote in my stead upon all matters that may come before the 2023 constituency meeting. I am not able to attend the 2023 Constituency meeting and the person below has agreed that he/she will act as my proxy to cast my vote in my stead upon all matters which may come before the annual Wildwood Sanitarium, Inc. Constituency meeting to be held April 16, 2023. Who will vote in your stead? * PICK ONE Alberta Cook Alison McLeod Allison Cordova Amarildo Souza Amy Fortunato Anna-Marie Berbel Barbara Rousseau Bob Payne Carin Lynch Charles Cleveland Charles Hightower (VPE) Chris Palafox Christine Payne Cristine Castillo Daniel Djami (T) Danique Tersmette Darlene Seath Debbrah Marawanyika Derrick Hamilton Dona Paulin Edward Sigh Eleida Feliciano Elizabeth Hall Erin Palafox Ervin Davis Esteban Beckford Fernando Ferreira Gaiscaly Hurtado Gordon Jura Gus Paulin Henri Du Plessis Herschel Hendley Joy Hamilton Joyce Grivas Joyleen Kafuka Julian Ruiz Kareece Moonasingh Larry Stapleton (S) (VPA) Latif Bervis Linda Bentancurt Lisa Choi Lisa Davis Liz Zapata Magda Sparrow Margaret Neverson Margarida Godinho Mark Chuljian Mark Sandoval? Mary Fisher Matuka Haangala May Hills Micalwyn Mariano Michelle Doucoumes Miriam Louis-Jeune Miroslaw Glowacki Nana Kwarteng Nellie Boykin Nicolae Cebotar Pablo Bentancurt Patty Stapleton Raven White Rhonda Jura Roby Sherman Scott Grivas Sergio Morales Shanniel Fisher Shawn Craig Sheila Suero Silvia de Jong Steve Cook Steve Dickman (CH) Steven Grabiner Svetlana Scherba Tapiwa Marawanyika Tina Jones Tom Brevig Valdene Vale Vanessa Cumberbatch Vaughan Sparrow (P) Verna Chuljian Victor Pile Victorija Rimko Vitalii Macarov Wayne Atwood Wilbur Atwood William Hartsook Xavier Hazen Yamian Peguero Yorsey Aguilar Are you also part of the board? * Yes No I am not able to attend the 2023 annual board meeting and the person below will act as my proxy to cast my vote in my stead upon all matters which may come before the 2023 board meeting. Who will attend the board meeting in your stead? * PICK ONE Charles Hightower (VPE) (Board Member) Daniel Djami (T) (Board Member) Jacob Moreno (Board Member) James Hartley (VP) (Board Member) Jeffrey Cumberbatch (Board Member) Joyce Grivas (Board Member) Larry Stapleton (S)(VPA)(Board Member) Linda Bentancurt (Board Member) Mary Fisher (Board Member) Pierre Potgieter (Board Member) Scott Grivas (Board Member) Steven Dickman (CH) (Board Member) Tapiwa Marawanyika (Board Member) Vaughan Sparrow (P) (Board Member) Wilbur Atwood (Board Member) Yamian Peguero (Board Member) Where are you coming from? Local Out-of-town If you live on or near Wildwood's campus, please check 'local'. Lodging Please indicate your lodging needs. I need lodging arrangements. I arranged with someone on-campus. I arranged lodging off-campus. Name of the person you are staying with: Please indicate the nights you need lodging: Friday Saturday Sunday Meals Will be served at the student cafeteria Please indicate the meals you are planning on having with us (out-of-town guests only): Friday supper Sabbath breakfast Sabbath lunch Sabbath supper Sunday breakfast Sunday lunch Sunday supper Monday breakfast Transportation Transportation needs * I don't need transportation/have my own I need transportation Please indicate your transportation needs from and to: Chattanooga Airport Bus terminal Groome's airport shuttle You may wait in the baggage claim area or the shuttle office for your ride. To make reservations (which are required) for shuttle service from Nashville or Atlanta airports to Chattanooga, you may call Groome Transportation at 423-855-7441 or 423-954-1400. Arrival Info Arrival date Arrival time 121234567891011 : 00153045 AMPM Airline Flight number Bus line Bus number Shuttle service Other relevant information Departure Info Departure date Departure time 121234567891011 : 00153045 AMPM Airline Flight number Bus line Bus number Shuttle service Other relevant information If you are human, leave this field blank. Submit
