Executive Women's Association | New Member Nomination

Membership Nomination Form

Nomination deadline is Monday, January 23. Please fill out form as completely as possible. Thank you!

* Name of Nominee:

* Home/Work Phone Numbers:

E-mail Address:

Nominator's E-mail Address:

* Current Address
(Business and/or Home):

* Employer:

* Category of Membership:
Business
Education
Gov't/Non-Profit/Religion
Licensed Degreed Professional

* Job Title:

Immediate Supervisor and Title:

Job Responsibilities:

Clearly represent executive
(senior) management?

Involved in policy-making?

Is she a key decision-maker?

Received significant recognition
in her field?

Maintained a strong
community influence?

Educational background:

Describe significant recognition
received in field:

Civic or Professional
Involvement (Boards):

Other Comments:

* Sponsor Name:

Names of Co-Sponsors:

* Required