Expert Team Nomination Form

All questions must be answered for the nomination form to be considered, except the expertise of the organization is optional if the nominee is representing him/herself.

Title:
Full Name:
Address:
Company or Organization:
Telephone Number:
Fax Number:
Email Address:
Representing:
Expert Team:
	If the nominee is chosen for the Expert Team, can the nominee information provided on this form be shared with the other members of the Expert Team? If the nominee is chosen for the Expert Team, can the name the company or organization (or the name of the nominee if he or she is participating as an individual) be identified publicly as a member of the Expert Team?
	Please provide the qualifications of the nominee relevant to this expert team. An attached biography or resume can be used instead of filling out this section.
	Please provide the expertise area of this organization (only if company / organization was included).