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* 1. Nominator's Name

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* 2. Nominator's Email

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* 3. Nominee's Name

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* 4. Nominee's Email

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* 5. Is the nominee a current CCGG member? 

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* 6. Does the nominee reside in northern California or southern California

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* 7. Does the nominee reside in an area of California that is designated as rural or frontier? 

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* 8. Please provide the nominee's institution, organization, or agency affiliation:

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* 9. Please summarize the nominee’s qualifications below.

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* 10. With the above nominee’s permission, I hereby nominate them for the following position serving from 7/1/2020 - 6/30/2022 (please check only one):

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