Nomination

Position Applying For: *

Name: *

Title: *

Institution: *

Member Since:

Current Academic Position(s):

Elected Position(s):

Leadership role(s) with SAEM and year(s):

List role(s) in major contribution to SAEM products:

e.g. author of X, developing Y, etc..

List committee(s)/task force(s)/interest group(s) membership and year(s):

Non-SAEM career accomplishments:

such as awards, grants, leadership positions, etc.

Personal Statement:

Please keep Personal Statements to one page or less

Optional Personal Statement Upload:

PDF only.

Attach letters of support:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Enter the characters shown in the image.