NACCU
Board of Directors Nomination Form

Self-Nominations are Encouraged!

Your Name:  

Your Title:  

Your Institution:  

Your Address:  

City:  

State:  

Zip Code:  

Phone Number:  

Fax Number:  

Email Address:  

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ABOUT THE NOMINEE:

Please submit a copy of the nominee's most recent resume with this form.

Name of Nominee:  

Number of years of nominee's membership in NACCU (if known):  

Background Summary:

Areas of Expertise:

Special Interest:

Please include names, titles, addresses, and phone numbers of two references who can verify the above information regarding this nominee. Letters of recommendation welcome.

Reference 1

Reference 1 Name:  

Title:  

E-mail Address:  

Phone Number:  

Fax Number:  

Street Address:  



Reference 2

Reference 2 Name:  

Title:  

E-mail Address:  

Phone Number:  

Fax Number:  

Street Address:  

Please print form before clicking the SUBMIT button so you have a record of your nomination.