Name of Nominee *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Does this person know they are being nominated? *

Yes

No

Have you discussed the following board members duties with them? *

• As a Board Member they will be expected to be a financial contributor to the organization. • As a Board Member they will be expected to purchase a season ticket. • As a Board Member they must be willing to raise funds for the organization. • As a Board Member they must be willing to actively serve on one or more committees of the organization.

Yes

No

Board Member Submitting the Nomination *

First Name

Last Name