MSPCA Leadership Nomination Form

MSPCA is an association, governed by an elected board of directors, supported by appointed committees, and lead by elected officers. Any eligible MSPCA member in good standing may be nominated to serve as a board or committee member. Nomination forms should be completed, with the approval of the member nominated. The Association Nominating Committee will review all director nominations, and recommend approved candidates to the Board. Election of new Board Members is conducted at our December Annual Meeting, in accordance with the Association’s by-laws. Members interested in serving on an appointed committee are also invited to submit a nomination form. Committee appointments are the responsibility of MSPCA’s president.
Interested in serving on The Board of Directors:
Interested in serving on a MSPCA Committee:

Contact Information

Nominee Name:
Title:
Member Company Name:
Member Company Address:
City:
State/Province:
Zip/Postal Code:
Country:
Work Telephone:
Cell Phone:
Email:

Career History

Professional Positions and Companies Served (earliest to current):
Year You Entered the Industry:
Company Name:
Number of Years:
Title:
Job Function:
Company Name:
Number of Years:
Title:
Job Function:
Company Name:
Number of Years:
Title:
Job Function:

Educational Background

School:
Degree/Certificate:
School:
Degree/Certificate:
School:
Degree/Certificate:

Additional Activities

Memberships in Professional or Civic Organizations:
Titles Held/Awards Received:
Skills/Interests/Talents:
Describe your most significant professional accomplishments to date:
Why do you wish to serve as a Board or Committee Member?
Sponsor Name (if this form is being submitted by someone other than the person named above):
Date: