CFM Affiliate Board Representative Nomination Form

Name *

First

Last *

Last

Email *

Phone *

This phone number is: *

Home

Cell

Work

Address *

Address

City

State/Province

Zip/Postal

Country

Age

Optional

Ethnicity

Optional

Indicate the PRIMARY area of emphasis of your/the nominee’s affiliate (choose only one): *

Previous experience (if any) with CFM:

Please indicate any of the following skills or experience you/the candidate possess: *

Other Affiliations or organizations you/candidate belong to (e.g. membership, professional, civic, conservation, etc.) *

Why are you/is candidate interested in representing ALL affiliates on the CFM Board? *

Submitted by (Affiliate Organization):

Name (First and Last): *

Email Address: *

Phone Number *

Date:

Has this person been contacted to determine their interest in being nominated? *

Yes

No

If yes, would he/she/you be willing to serve if elected?

Yes

No

Attach Biography, Resume, or CV

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Date

Missouri River Bird Observatory