NYCRA Board Officer Nomination Form

NYCRA Board Officer Nomination Form

Nominate yourself or someone you trust for an NYCRA officer position. Provide accurate information and submit only one nomination.
Open Positions (2-Year Terms)
- President
- Vice President
- Secretary
Elected officers will serve during the:
- 2026–2027 fiscal year
- 2027–2028 fiscal year
Eligibility: Any active NYCRA member in good standing is eligible to hold office. Please refer to the qualifications sheet for additional details.
Nomination Types
1. Nomination of Self
I, would like to nominate myself :

First NameLast Name
For the position of:
Signature:
2. Nomination of Another
I would like to nominate:

First NameLast Name
Position:
Term:
Please submit nominee's most current resume:

Cancelof
Nominator Name:

First NameLast Name
Nominator Signature:
Candidate Information
Name:

First NameLast Name
Position Sought:
Facility:
Phone Number:
Format: (000) 000-0000.
Email:
Mailing Address
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Education
Work Experience
Cancer Registry Activities
Signature:
Full Name

First NameLast Name
Email Address
Are you a current NYCRA member in good standing?
Please upload current resume:

Cancelof
If you have any comments or suggestions regarding the election process, please share them here:
Please sign below to confirm your nomination.
Date:

MonthDayYear
Date
Please complete the captcha to verify you are not a robot.
Should be Empty:

Nomination Types