Executive Committee Member Nomination Form

Please select the desired position: *

Member At Large

Secretary/Treasurer

Name of nominee: *

Nominee's Organization: *

Nominee's Title: *

Does the nominee have the time and commitment to serve a two-year term?: *

Yes

If other than a self-nomination, has the nominee assented to be nominated?: *

Yes

N/A

In what previous leadership positions has the nominee served?: *

What other attributes does the nominee have that makes him/her a good candidate for this position?: *

Include a short bio (150 words or less) of the nominee. (You may choose to attach the bio instead if you prefer - see below):

Include a short bio (150 words or less) of the nominee (txt, rtf, pdf, doc):

Submitted by: *

Date: *