Nominations - New Item

Submitted By: *

Please provide your first and last name, e.g. Aref Dajani.

Your Current Division *

Please provide your home division ID.

Office *

District Governor

Lt. Governor Education & Training

Lt. Governor Marketing

Division A Governor

Division B Governor

Division C Governor

Division D Governor

Division E Governor

Division F Governor

Division G Governor

Division H Governor

Division I Governor

Division J Governor

Please select the office (offices) for which you would like the nominating committee to consider this individual:

First Name *

Please provide the first name of the person you are nominating.

Last Name *

Please provide the last name of the person you are nominating.

Designation

CC

AC

CL

AL

DTM

Please choose all TM educational achievements this nominee has earned.

Address

Please complete the address information for your nominee.

City

State

Zip Code

Primary Phone

What is the best number to reach your nominee? e.g. 703.555.5555

Primary Email

What is the primary email for your nominee?

Home Club Name

What is the name of your nominee's home club?

Home Club Number

What is the number of your nominee's home club?

Recommendation

Please describe any club and district offices held by nominated individual (include dates of service if possible). Please share with the nominating committee why you believe the nominated individual should be considered for the specified position. If there is additional information you would like to include about this candidate that you feel would assist the nominating committee in their deliberations, please attach it to this form by clicking on the paper clip icon at the top of the form.

Attachments

D27 Nominating Committee