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2017 Board Nomination Form
2017 Board of Directors Member Nomination Form
Submission Deadline
Nominations close July 28, 2016.
Name of Candidate:
*
Candidate's Current Job Title:
State/Territory:
*
Candidate's Phone:
*
Email:
*
How long has candidate been in this position?
*
How long has candidate worked in public health?
*
(# of years)
Has candidate served on any other boards? (If yes, please list organization(s) or n/a if no)
Add organizations here, one organization per line
Does candidate have any experience with the following?
*
Strategic or long-term planning
Understanding of financial reports
Partnership development/networking
Is the candidate's supervisor supportive of the role and time required of this responsibility?
*
Yes
No
Please Describe the Reason for Your Candidate's Nomination
Provide explanation:
*
500
of 500 characters remaining
CV Upload:
*
Upload Nominee's CV Here
Your Name:
*
Enter Name and email here
Your Phone:
Your Email:
*
Validation Code:
Answer this simple math problem to validate your submission:
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National Association of Chronic Disease Directors
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Decatur, GA 30030
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