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Officer Nomination Form - 2017


Complete the following form to nominate officers for the upcoming year. It is not necessary to list someone for each position. Please secure the permission of the nominee before submitting his/her name. This year the open positions are: President-Elect, Secretary, Oklahoma Delegate, and Texas Delegate.

Deadline for submission - June 30, 2017

President-Elect: This person serves for one year in preparation for the year as President. The President acts as the chief executive officer of the association providing leadership and serving as the official spokesperson of the Association. In the year immediately following the Presidential year, the person serves on the Board of Directors as the Immediate Past President.
 Nominee's First Name
 
 Nominee's Last Name
 
  Nominee's Institution
 

 Nominee's Title
 

 Nominee's Email Address
 
 Nominee's Phone
 (Area Code + Number, Extension)
     EXT: 
 Nominee's Fax
 (Area Code + Number)
 

Secretary: This person serves as a Board Member and is responsible for keeping and maintaining the records of the Association and Board of Directors and for the mailing of meeting notices and such other communications. The term of office is two years.
 Nominee's First Name
 
 Nominee's Last Name
 
  Nominee's Institution
 

 Nominee's Title
 

 Nominee's Email Address
 
 Nominee's Phone
 (Area Code + Number, Extension)
     EXT: 
 Nominee's Fax
 (Area Code + Number)
 

Oklahoma Delegate-at-Large: This individual serves as a Board member representing the general membership for the purpose of discussing issues and concerns brought before the Board of Directors. The term of office is two years.
 Nominee's First Name
 
 Nominee's Last Name
 
  Nominee's Institution
 

 Nominee's Title
 

 Nominee's Email Address
 
 Nominee's Phone
 (Area Code + Number, Extension)
     EXT: 
 Nominee's Fax
 (Area Code + Number)
 

Texas Delegate-at-Large: This individual serves as a Board member representing the general membership for the purpose of discussing issues and concerns brought before the Board of Directors. The term of office is two years.
 Nominee's First Name
 
 Nominee's Last Name
 
  Nominee's Institution
 

 Nominee's Title
 

 Nominee's Email Address
 
 Nominee's Phone
 (Area Code + Number, Extension)
     EXT: 
 Nominee's Fax
 (Area Code + Number)
 


 Submitted By:
 First Name
 
 Last Name
 
 Institution
 

 Email Address
 
 Phone
 (Area Code + Number, Extension)
   EXT: 
 Fax
 (Area Code + Number)
 


Submit online or return this form to:

Janell R Valdez, Nominations Chair
Associate Director of Financial Aid, Health Sciences Center
University of New Mexico
1 University of New Mexico
MSC 09 5300
Albuquerque, NM 87131-0001
Phone: (505) 272-8008
Fax: (505) 272-2954
Email: javaldez@salud.unm.edu







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