New NAWIC Committee Member Nomination Form

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* 1. Personal details

First Name

Last Name

City/Town

State/Territory

Postal Code

Email Address

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* 2. Select your Chapter (must be the state/territory you reside in)

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* 3. Membership ID number (You must be a paid NAWIC member to join our committees if you are yet to join please put TBA in this section. )

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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:

Committee Member

Please specify your interests or the committee you wish to join: (eg: events, education, marketing, sponsorship etc.)

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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 and the NAWIC Constitution

Yes - I declare