Board of Directors Nomination Form

Who is completing this nomination form?*

Nominee (Self-Nomination)Nominator

Nominee Information

Title*

First Name*

Last Name*

Suffix*

Address*

City*

State*

Zip*

Phone

Email*

Professional Organization

Professional Title

Select Board Role Interested In (Select All that Apply)

PresidentVice PresidentSecretaryTreasurer

For more information and descriptions of each committee, please click here.

General Board Seat

Biography

What skills would the nominee listed above bring to the Board of Directors?

Affiliations or organizations the nominee belongs to (e.g., membership, professional, civic)

The nominees' prior and current board/committee experience

Signature

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