Nominator Information
Name of Nominator
*
First Name
Last Name
Nominator Email
*
example@example.com
Nominator Affiliation
*
Are you a current SSR member?
*
Yes
No
Back
Next
Nominatee Information
Select BOD Position
*
Please Select
Vice-President Elect
Secretary
Treasurer-Elect
Director
Director, Early Career Investigator
Name of Nominee
*
First Name
Last Name
Affiliation of Nominee
*
Ethnicity/Race
*
Please Select
Hispanic or Latino
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
White
More than one
None of the above
Do not wish to disclose
Gender of Nominee
*
Please Select
Female
Male
Non-binary
Transgender
Prefer not to answer
Link to Nominee's Professional Page
*
Has the Nominee Confirmed His/Her Willingness to be Nominated and to Serve if Elected?
*
Yes
No
Submit
Should be Empty: