Nomination Form - National Board Position

NOMINATION FORM FOR NATIONAL BOARD POSITION

Please complete this form and submit by May 31.

Nominee Name:*

First

Last

Address:

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Phone:

Area Code

Phone Number

E-mail:*

Employer:*

Position:*

Credentials:*

Year Joined CSGNA:*

Chapter/National Positions Held:*

Committee Participation:*

Other related activities:*

Reasons(s) for submitting the nomination for National Office: (can include your objectives, position statement, purpose, interest) *

Upload CV/Resume:*

Nominator 1 Name:*

First

Last

Nominator 2 Name:*

First

Last

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