ANVC Candidate Nomination Application - 2021

Nomination applications must be submitted electronically
The information provided in the application will be reproduced as presented for the ballot
If you have questions, please email nominating-committee@anvc.org

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* 1. Position for which you are submitting for:

ANVC Board as Member-at-Large

Leadership Development Committee

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* 2. Contact Information

Name

Company

Address

City/Town

State and Zip Code

Time Zone (Interviews will be held via telephone)

Email Address

Home Phone Number

Work Phone Number

Cell Phone Number

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* 3. Are you a current ANVC member?

Yes

No

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* 4. Candidate Statements

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* 5. Please upload your full CV that highlights your Employment, Education, Credentials, Awards, etc.

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* 6. Please upload a photo in .jpg format

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* 7. I will provide the ANVC with references using the ANVC Candidate Reference Form.

Yes

No

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* 8. I have read and agree to abide by ANVC's Conflict of Interest and Confidentiality Policy if elected to the Board or selected for a Committee position and agree to disclose all conflicts of interest. A copy of the Conflict of Interest Policy can be found on the ANVC website: www.anvc.org/COIpolicy.

Yes

No

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* 9. CONFLICT OF INTEREST DISCLOSURE FORM

No, I have no relevant personal, financial and/or "competitive" relationships

Yes, I do have personal, financial and/or "competitive" relationships (If yes, proceed to next question)