* 1. Your name:

* 2. Your email:

* 3. The name of the individual you wish to nominate to the GHC Board of Directors:

* 4. Please provide the nominee's contact information (required):

* 5. What sector does the nominee represent?
(Please check all that apply)

* 6. Why should this nominee be elected to the GHC Board of Directors?

* 7. Please include a short bio of the nominee:
(500 words or less)