EBC Board of Directors Nomination Form | Environmental Business Council of NE

Nominee's Name - please include middle initial*

First Last

Company*

Title*

Email Address*

Phone*

Address*

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

Visit the online EBC Member Directory for a current list of EBC Member companies: http://ebcne.org/ebcne-member-directory/

Does the nominee work for an EBC Member company?*

Summary of Nominee’s Attributes and Qualifications for Board Membership*

Nominee’s Technical Practice Disciplines*

Nominee's Likely Committee and/or Chapter Involvement*

Sponsoring Board Member e-Signature*

First Middle Last

Co-Sponsoring Board Member e-Signature (a second signature is required)*

First Middle Last