ICOM-US Student Discounted Promotion Program- Nominations 2020

Question Title

* 1. Please provide your contact information (in case we need to follow up regarding your nominations):

Name

Institution

Title

City/Town

Email Address

Phone Number

Please provide your student nominations below (only up to 3):

Question Title

* 2. (Student One) Nomination:

Name

Institution

Program Enrolled (Major)

Email Address

Phone Number

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* 3. (Student One) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Please bill the student directly for the membership cost

Please bill the Institution, we will cover the membership cost

Other (please specify)

Question Title

* 4. (Student One) Please briefly tell us why you are nominating this student for ICOM-US Membership:

Question Title

* 5. (Student Two) Nomination:

Name

Institution

Program Enrolled (Major)

Email Address

Phone Number

Question Title

* 6. (Student Two) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Please bill the student directly for the membership cost

Please bill the Institution, we will cover the membership cost

Other (please specify)

Question Title

* 7. (Student Two) Please briefly tell us why you are nominating this student for ICOM-US Membership:

Question Title

* 8. (Student Three) Nomination:

Name

Institution

Program Enrolled (Major)

Email Address

Phone Number

Question Title

* 9. (Student Three) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Please bill the student directly for the membership cost

Please bill the Institution, we will cover the membership cost

Other (please specify)

ICOM-US Student Discounted Promotion Program- Nominations 2020

Question Title

* 1. Please provide your contact information (in case we need to follow up regarding your nominations):

Question Title

* 2. (Student One) Nomination:

Question Title

* 3. (Student One) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Question Title

* 4. (Student One) Please briefly tell us why you are nominating this student for ICOM-US Membership:

Question Title

* 5. (Student Two) Nomination:

Question Title

* 6. (Student Two) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Question Title

* 7. (Student Two) Please briefly tell us why you are nominating this student for ICOM-US Membership:

Question Title

* 8. (Student Three) Nomination:

Question Title

* 9. (Student Three) Regarding membership payment, please choose one option below in regards to this student (discounted fee of $30):

Question Title

* 10. (Student Three) Please briefly tell us why you are nominating this student for ICOM-US Membership:

Question Title

* 11. Any additional comments/suggestions: