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Executive Committee Nomination Form

* Required      
Name * ASCE/EWRI ID# *
Address *
City * State * Zip * Home Phone *
Preferred E-mail Address * Alternate E-mail Address
Preferred Fax Number * Alternate Fax Number
Nominated for Chair of *
Job Title *
Employer *
Employer's Address *
City * State * Zip * Work Phone *
Preferred Fax Number * Alternate Fax Number
Educational Background (degrees and dates) *
EWRI/ASCE Service (list committees and positions held): *
Other Professional & Technical Organizations (list organizations held): *
The foregoing is presented for consideration by the * Committee/Council for appointment as chair of the named Executive Committee. I fully understand the responsibilities of the assignment and am willing to serve, if appointed.

By signing below you agree that the information provided in this form is correct and accurate.
Date * Signed by: *