NOMINATION FORM

Nomination deadline:  open until filled

Question Title

* 1. Nominee's Name (first/last)
(only self-nominations are accepted)

Question Title

* 2. Nominee's discipline

Question Title

* 3. GWC Email

Question Title

* 4. Status

Question Title

* 5. Select the area you wish to represent:

Question Title

* 6. Statement of Interest
Please write a BRIEF (2-3 sentences) statement explaining your reason for wanting to serve. May include accomplishments, expectations, goals, etc. as they relate to the committee's mission and charge. Statements of Interest are reviewed as part of the election process.

T