Nomination Application and Consent to Serve

 
100% of survey complete.
Candidate Information:
Full Name and Credentials (as it should appear on the ballot):

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* 1. Full Name and Credentials (as it should appear on the ballot):

Current Position:

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* 2. Current Position:

Current Employer:

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* 3. Current Employer:

Employer Address:

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* 4. Employer Address:

Candidate's Campaign Statement (250-300 words, including your research and leadership background to your service in a leadership role in SNRS):

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* 5. Candidate's Campaign Statement (250-300 words, including your research and leadership background to your service in a leadership role in SNRS):

If nominated and elected by the SNRS membership, I am willing to serve this term from 2017-2019 in the office of:

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* 6. If nominated and elected by the SNRS membership, I am willing to serve this term from 2017-2019 in the office of:

By completing this form, you are authorizing SNRS Headquarters to submit your name to the SNRS Succession Planning and Nominations Committee for consideration as a candidate for office. Notification of official slate of candidates will be sent by mid-October.
REMINDER: You must provide a copy of your CV and photo to amcrosse@kellencompany.com

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