Board Nomination

Instructions:

Please complete all the information below and click the send button.

Name of person submitting nomination

Email of person submitting nomination

Are you a KSHN member Yes No

First Name

Last Name

Is nominee a member of KSHN? Yes No Do not know

Title

Email Address

Phone Number

Street

City

State

Zip code

Represention Business Education Government Labor

Please provide a brief summary of nominee qualifications: