2026 Nomination to Fellow
Nominations will be sent to Chair of Nominations and Elections Committee, Adriana Flores, Ph.D (adriana@dunflo.com)
Nominee's Name
*
First Name
Last Name
Nominee’s Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominated By
*
First Name
Last Name
Nominator’s Email
*
Nominee’s Email
*
Nominee’s Office Telephone Number
*
-
Area Code
Phone Number
Nominee's Home Telephone Number
-
Area Code
Phone Number
Has Nominee been a Member of GPA for the past five years?
*
Please Select
YES
NO
Brief description of Nominee’s professional experience/qualifications for the previous five years:
*
Description of Nominee’s professional service and/or accomplishments:
*
Description of Nominee’s professional service/contributions specifically to GPA:
*
GPA Fellow Endorsement Signature (two fellow endorsements are required)
*
GPA second fellow endorsement signature
Submit
Should be Empty: