2008 AGS BOARD Nomination Form
Nominations for committee service commencing in May of 2008 open on
June 1, 2007 and run through October 1, 2007

This form should be completed only if you are nominating someone else to serve on the Board. If you are interested in a Self-Nomination, please fill out the 'Nominee Information Form'.

Please Provide us with YOUR information (Nominator):

First Name
Last Name
Degrees
Primary Email Address
Primary Phone Number

Have you served/or are you currently serving on any AGS Committees or the AGS Board?
 Yes
 No

If Yes which one(s), and please list dates of service?

Please Provide the following information FOR THE PERSON YOU ARE NOMINATING: (Nominee):

First Name
Last Name
Degrees
Primary Email Address
Primary Phone Number

Is the nominee an AGS Member? (Please Note: You must be an AGS Member to sit on an AGS Committee or Board)
 Yes
 No
 Don't Know

Please describe why you think the nominee should sit on the AGS Board, and what you feel they could contribute as a Board member:
Please limit to 200 words or less

Additional Comments/Information about Nominee:
Please limit to 200 words or less


 I am aware that in order for this application to be complete, the nominee will be contacted by AGS Staff and asked to submit the following documents to ccampanelli@americangeriatrics.org by Monday, October 1, 2007:

  • Nominee Information Form
  • A 2-page biographical sketch or short curriculum vitae
  • Letter of support from a past/current AGS Board Member. (If you are a current/past board member who is nominating this member to serve on the AGS Board, then this form will be considered the nominee's letter of support)



   


 

 
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