ALSN Nominations Form

Applications are due by 31-Oct
Name*

First NameLast NameCredentials
Email*
Cell phone*
Location*

Street Address

Street Address Line 2

CityState/Province

Zip CodeCountry
Select the Position*

Director of CommunicationsDirector of Philanthropy
Please Provide a Photo*

Browse Files

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Please Upload Your CV / Resume*

Browse Files

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Highlight your qualifications and what you would bring to the role*

These comments will be shared with members on the ballot.0/250
Conflict of Interest

An actual or potential conflict of interest exists when an Interested Person has the ability to control or influence a transaction or arrangement on behalf of ALSN and has a financial interest or relationship that is directly or indirectly related to such transaction or arrangement, and the Interested Person’s actions on behalf of ALSN are likely to be compromised by the Interested Person’s financial interests or relationships, particularly if those interests or commitments are not disclosed.
Select one of the Following*

I have no conflict of interest to report.I have the following conflict of interest to report.

Conflict of Interest Confirmation*

I hereby certify that the information set forth above is true and complete to the best of my knowledge
Nomination Confirmation*

I understand that with my submission of this nomination form, I am acknowledging my capacity to fulfill the requirements of the position selected above.
Please verify that you are human*
Should be Empty:

	Name of Org/Entity	Who has conflict (self, spouse, family member)	Type of conflict	Identify conflict (personal, business, volunteer)
Conflict 1
Conflict 2
Conflict 3
Conflict 4
Conflict 5
Conflict 6

Applications are due by 31-Oct