Board Nomination Form

2021 Executive Board Positions Nomination Form

2021 Executive Board Positions Nomination Form

Board Position

Please select a board position. *

Name of Person Completing Form

First Name *

Last Name *

Position and Institution *

Email *

Phone *

Number of years with HEAL (or AECMN/APHOES) *

This is a self-nomination. *

Yes

No

Name of Nominee

First Name *

Last Name *

Position and Institution *

Email *

Phone *

Your association with nominee *

In 100 words or less, please tell us about your nominee and what s/he could bring to the HEAL Executive Board. *

Please indicate the best day and time for a member of the Nominating Committee to contact you. Please indicate time zone. *

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