National Association of Campus Card Users
Board Nomination Form

Please complete and send by September 9, 2011.
Self-Nominations are encouraged!

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NOMINEE INFORMATION:

Name:
  

Title:
  

Institution:
  

Mailing Address:
  

City:
  

State/Province:
  

Zip/Postal Code:
  

Phone Number:
  

Fax Number:
  

Email Address:
  

Number of years nominee has been involved in the campus card industry:
  3 (minimum required for nomination 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 or more

Summary of nominee's involvement in the campus card industry:

Number of years nominee has been involved in NACCU:
  3 (minimum required for nomination 4 5 6 7 8 9 10 11 12 13 14 15 or more

Summary of nominee's involvement in NACCU:

List the number of NACCU Annual Conferences nominee has attended during the last 10 years:
  1 (minimum required for nomination) 2 3 4 5 6 7 8 9 10

Nominee's special interests within the campus card industry and NACCU:

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NOMINATOR INFORMATION:
(Leave this section blank if this is a self-nomination)

Name:
  

Title:
  

Institution:
  

Mailing Address:
  

City:
  

State/Province:
  

Zip/Postal Code:
  

Phone Number:
  

Fax Number:
  

Email Address:
  

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Electronic Signature - type name of nominator to make nomination official

After submitting this form, please send a copy of the nominee's most recent resume and two professional references to naccu@naccu.org or fax to 602-395-9090. Feel free to include additional pages as needed.

Please print form before clicking the SUBMIT button so you have a record of your nomination.