CSBG Regional Rep Nomination Form Deadline for Nominations August 31, 2020

Nominated as candidate for position of:*
Please select Region and whether you are nomination for the Rep or the Alternate position. Note: If you are nominating for the Rep position, you do have the choice to agree that if the candidate does not win the Rep seat, they should be considered for the Alternate position.
Nominee:*
Title*
Organization*
Street Address:*
City/State/Zip*
Telephone*
Email Address*
My nominee, if not elected to the Representative position, is interested in serving as the Alternate:*
- Yes
- No
Comments:
Submitted by:*
Organization*
Email*
If you are nominating another, have you discussed with the nominee?
- Yes
- No
Date*
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