SMEMSIC Board of Directors Nomination Form

Please provide the following information: Do not hit the enter key on your keyboard until you have completed the form or it will be submitted before you are complete. Use the tab key or your mouse to navigate between the form fields. You must submit a digital picture after submitting this form to complete the nomination process. Your picture will be placed on the web site with your answers to the below questions for members to view before submitting their ballots. Please have a digital picture ready to submit after completion of the form.

Please select the position you wish to be nominated for from the list below.

President Elect
Historian
Secretary
Region 1 Representative
Region 2 Representative
Region 3 Representative
Upper Peninsula Representative

Please provide a brief description below of what you feel you have to offer our membership by serving on the Board of Directors.

Please provide a brief biography below for our members to review on the voting form.

Nominee Contact Information
Other than your name, contact information will not be provided on the voting form.

First Name

Last Name

Address 1

Address 2

City

State

Zip / Postal Code

Home Phone

Work Phone

E-mail

Fax

First Name
Last Name
Address 1
Address 2
City
State
Zip / Postal Code
Home Phone
Work Phone
E-mail
Fax