2018-2019 NOHIMSS Board Nomination Form

Full Name

Question Title

* 1. Full Name

Organization Name

Question Title

* 2. Organization Name

Title

Question Title

* 3. Title

Email Address

Question Title

* 4. Email Address

Contact Phone Number

Question Title

* 5. Contact Phone Number

Have you been a member (in good standing) of HIMSS and NOHIMSS for over 1 year?

Question Title

* 6. Have you been a member (in good standing) of HIMSS and NOHIMSS for over 1 year?

Are you nominating yourself or someone else?

Question Title

* 7. Are you nominating yourself or someone else?

If you are nominating someone else, please enter their: Name, Organization, Title, Email Address, & Contact Phone Number.  If you are nominating yourself, please enter: N/A

Question Title

* 8. If you are nominating someone else, please enter their: Name, Organization, Title, Email Address, & Contact Phone Number.  If you are nominating yourself, please enter: N/A

What NOHIMSS Board Position is your nomination for?

Question Title

* 9. What NOHIMSS Board Position is your nomination for?

T