NCSEA 2023 Board of Directors Nomination Form

Can you devote approximately 5 – 10 hours per month to NCSEA? *

Yes
No

First Name *

Last Name *

Address 1 *

Address 2

City *

State/Province *

Zip *

Country *

Length at Resident *

Business Phone

Cell Phone *

Email *

Occupation *

Title *

Company Name *

Short Biography:

Related Activities:

Name of NCSEA affiliate that recommended you consider NCSEA Board of Directors Service: *

References:

Please list at least 2 references with contact name and phone number.

Reference 1

Reference 1 Name *

Reference 1 Phone Number *

Reference 1 Email *

Reference 2

Reference 2 Name *

Reference 2 Phone Number *

Reference 2 Email *

Reference 3

Reference 3 Name

Reference 3 Phone Number

Reference 3 Email

As part of your application a headshot/photo is required. Please submit a photo via email to Victoria Somol at victoria@energync.org.