Please enable JavaScript in your browser to complete this form.Nominator's InformationEmail *Prefix---Choice 7Dr.MissMr.Mrs.Ms.Name *FirstMiddleLastJob Title *Institution/Organization *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWork Phone *Vice-PresidentThe Vice President/President-Elect serves a three year term (Vice President in Year 1; President in Year 2 and Immediate Past President in Year 3).Nominee for Vice-PresidentFirstLastInstitutionJustification for NominationCommunications OfficerThe Communications Officer will serve a two-year term.Nominee for Communications OfficerFirstLastInstitutionJustification for NominationTreasurerThe Treasurer will serve a two-year term.Nominee for TreasurerFirstLastInstitutionJustification for NominationNominating CommitteeNominating Committee members serve two-year staggered terms. You may submit up to two nominees for the Nominating Committee.Nominee for Nominating Committee - 1FirstLastInstitutionJustification for NominationNominee for Nominating Committee - 2FirstLastInstitutionJustification for NominationWebsiteSubmit
