NEPCSA Committee Nomination Form
Company
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Address
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City
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State
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AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
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Phone
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Fax
Contact Name
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Email
I would like to nominate:
Name
*
Email
to serve on:
Committee:
*
Board of Directors
Education Committee
Membership Committee
Connecticut Government Affairs Committee
Massachusetts Government Affairs Committee
New Hampshire Government Affairs Committee
Rhode Island Government Affairs Committee
For further information contact: Catherine Flaherty | 508-695-3919 | catherine@nepcsa.org
