Please enter your Full Name. *

Please enter your Email Address and Phone Number. *

Please enter the Name of the person you are nominating. *

Please enter the Email Address and Phone Number of the person you are nominating. *

What role(s) are you nominating the person for? *

Note: Roles with the asterix (*) are required to be voted upon by the Chapter Membership.

Please enter how you know the nomination candidate. *

Note: If the nomination candidate is yourself, please just respond "self" in the blank.

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