Please complete the following about yourself:

            Name 
           Title 
    Organization 
      Work Phone 
          E-mail 

Please provide the following contact information for the nominee:

            Name 
           Title 
    Organization 
      Work Phone 
          E-mail 

Is this nominee a YES member?
Yes No
 

Why should this nominee be chosen for membership?

Is the nominee aware of the monthly 5 to 7 hour time commitment and required attendance at both FPDA conferences?  

Yes No

What will you do to ensure that the nominee, if accepted, will thoroughly prepare for and actively contribute to achieving the SEC's objectives?

Do you agree to be responsible for the $1,750 participation fee and the nominee's travel and other related expense?

Yes No