2023 Board of Directors Nomination Form

2023 Board of Directors Nomination Form
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email *
example@example.com
Phone Number

Area Code Phone Number
ICEA Membership Number *
Please select the position of interest: *
Please answer the following questions below.
Provide background information on nominee (past and present work experience, experience with local group or community contributions to childbirth/parent education, work in ICEA, support of family-centered maternity care, etc.). *
List the goals and directions you would like to see ICEA adopt for the next three years. *
Do you have the time and commitment to give to the position? *
Do you have access to a computer and access to the Internet for e-mail? *
Provide a listing of your capabilities for the position of interest: *
What particular strengths or interests will make you an asset to the ICEA Board of Directors? *
Please upload a resume or curriculum vitae: *

Browse Files

Cancel of
Please provide contact information for 2-3 individuals who can provide information regarding your interest, capabilities and accomplishments. At least one reference must be an ICEA member.
Reference 1 Name:

First Name Last Name
Reference 1 Email:
example@example.com
Reference 1 Phone Number

Area Code Phone Number
Reference 2 Name:

First Name Last Name
Reference 2 Email:
example@example.com
Reference 2 Phone Number

Area Code Phone Number
Reference 3 Name:

First Name Last Name
Reference 3 Email:
example@example.com
Reference 3 Phone Number

Area Code Phone Number
Before you submit your nomination form, please be sure to print a copy for your files.
Should be Empty: