NCSRC - Official Nomination Form

As an Active or Life member of the NCSRC, Inc.?? I have reviewed the CRITERIA FOR CANDIDATE NOMINATION and submit the members listed below for consideration as candidates.?? I understand that I do not need their permission and that their membership status and eligibility shall be verified in accordance with established criteria.

CATEGORY

NAME OF MEMBER and MAILING ADDRESS

President-Elect:

Vice President:

Secretary:

Treasurer:

Board of Directors:

Delegate:

Your Name:

AARC Membership #

You may send via e-mail to: Travis Houston at travis.houston@caromonthealth.org
Thank you in advance for your nominations, we will announce at the NCSRC annual meeting in September. April 15 IS DEADLINE FOR SUBMISSIONS.