Central States ACSM Regional Chapter
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Officer Nomination Form
Nominee's Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone
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)
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E-mail Address
What office(s) are you nominating the above person for? (RCC Rep., MO State Rep., Secretary/Treasurer or President-elect)
Briefly describe why the nominee is a good candidate for the position(s)
If you are nominating someone other than yourself, please list your name and e-mail address
ARKANSAS · KANSAS · MISSOURI · OKLAHOMA