Board of Directors Nomination Form

Nominate yourself or an alumna/alumnus to serve on the WMAA Board of Directors. Elections are held each spring.

"*" indicates required fields

I'm nominating

myself

someone else

Name*

First Middle Last Suffix

Nominee Name*

First Middle Last Suffix

MD Graduation Year*

YYYY

Specialty*

Preferred Email*

Preferred Phone*

Preferred Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Explain your interest in serving on the WMAA Board of Directors.*

Why do you recommend the nominee for service on the WMAA Board of Directors?*