Biographical Fact Sheet for Chapter Leadership Candidates

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The information requested will be used in making nominations for elected and/or appointed positions. The information is essential for the careful consideration of a nominee. Please be complete and specific in your responses. All of the information should be filled out by the nominee.

NOTE: All members elected and/or appointed to a position, must remain in good standing for the duration of their term as a volunteer leader of this association.

Deadline: February 24, 2023

First Name *

Last Name *

Middle Initial(s)

Job Title

Place of Employment

Job Location (City)

Preferred Mailing Address *

Email *

Work Phone Number

Home Phone Number *

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