Board Member Nomination Form

Nominator's name and credentials

Nominator's email address

Nominee's name and credentials

Nominee's email address

Nominee's professional affiliation/employer

Please summarize the Nominee's qualifications and your reason for nominating them. (Type below or copy and paste from another document)

Have you verified the Nominee's willingness to serve on the SWHPN Board of Directors?
YesNo

Please attach a copy of the nominee's Curriculum Vitae.

Attached files must be: .doc, .docx, .txt, or .pdf under 2MB.

To verify this submission, please type the letters and/or numbers you see above.

All fields are required.
Please double check that you have completed the entire nomination form.
When finished, click the send button below.

(Please be patient... it may take up to a minute for your file to upload.)