KEMSA Board Member Nomination Form
All nomination forms must be submitted no later than June 10th.
Personal Information
Name
*
First Name
Last Name
Organization
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
KEMSA Member
*
Yes
No
Member Type
*
Service
Squad
Back
Next
Requirements
One page nomination statement
*
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Letter of support from your employer
*
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of
Bio
*
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A current high quality digital photo.
*
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of
Submit
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