NAWIC AGM and Election - Nomination Form

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* 1. Please select a chapter

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* 2. Personal details

First Name *

Last Name *

Address

City/Town *

State/Territory *

Postal Code *

Country *

Email Address *

Phone Number *

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* 3. Membership ID number (or type 'Membership Pending' If you do not have a NAWIC membership)

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* 4. Nominee Name (You can enter your own name or another members name)

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* 5. For the position of:

Office Bearer

Committee Chair

Committee Member

Any of the above

Please specify the position: (eg: vice president, sponsorship chair)

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* 6. Declaration: I confirm that I have read and I agree to abide by the NAWIC Chapter Code of Conduct.

Yes - I declare

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* 7. Declaration: I confirm that I am a current member of NAWIC and acknowledge that by submitting this electronic nomination I agree to abide by the NAWIC Chapter Management Policy for Chapter Council Elections.

Yes - I declare