ABPLM 2018 Board of Directors Nominations

Use this form to make your nomination(s) for consideration for appointment to the ABPLM Board of Directors. Self-nominations are welcome. Nominees must complete the nominee interest form found on the ABPLM website at: http://tinyurl.com/abplm-nominations. If you are nominating yourself, please fill out the interest form by March 31, 2016. If you are nominating someone else, ABPLM staff will follow up with your nominee to provide the link for them to complete the form.

Deadline for nominees is May 1, 2018.

Question Title

* 1. I hereby nominate the following individual(s) for consideration to the ABPLM Board of Directors. (Please enter your full name below).

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* 2. Please enter your nominee's contact information below.

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 3. I have contacted this nominee to ascertain his/her interest in and availability to serve on the ABPLM Board.

Yes

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* 4. If you have more than one nominee, please enter the next nominee's contact information below.

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 5. I have contacted this nominee to ascertain his/her interest in and availability to serve on the ABPLM Board.

Yes

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* 6. Please enter the next nominee's contact information below.

Name:

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

Question Title

* 7. I have contacted this nominee to ascertain his/her interest in and availability to serve on the ABPLM Board.

Yes