Society of Correctional Physicians - Board of Directors Nomination Form

Help select who will represent you and your concerns in the Society. You are invited to nominate an SCP member for any of the following offices. Self-nominations also are welcome. You needn't nominate someone for every position. Please provide as much information as possible for each person you nominate.

I nominate the following SCP member(s) to serve a two-year term on the SCP Board of Directors.

President-Elect

Name

City, State ,

Phone (xxx) xxx-xxxx

Secretary

Name

City, State ,

Phone (xxx) xxx-xxxx

Treasurer

Name

City, State ,

Phone (xxx) xxx-xxxx

East Coast Director

Name

City, State ,

Phone (xxx) xxx-xxxx

Midwest Director

Name

City, State ,

Phone (xxx) xxx-xxxx

West Coast Director

Name

City, State ,

Phone (xxx) xxx-xxxx

Nominator Information

Your Name

Your Email

Your Phone (xxx) xxx-xxxx