MDHI Committee Chairperson Nomination Form Coordinating Committee Nomination Form Note: Please complete this form if you are nominating someone other than yourself. We will send each nominee an invitation to fill out an application. If you are self-nominating, you may skip this form and simply fill out an application. OK Question Title * 1. Your contact information: Name Organization (if applicable) Email Address Phone Number OK Question Title * 2. Nominee's contact information: Name Organization (if applicable) Email Address Phone Number OK Question Title * 3. Describe why you are nominating this candidate. OK DONE