Home
Other Info
About Us
Board of Directors
Membership
Scholarships
Contact Us
Instructions:
Please complete all the information below and click the send button.
Your Information
Name of person submitting nomination
Person Name is required.
Email of person submitting nomination
Person Email is required.
Invalid Email ID
Are you a KSHN member
Yes
No
Nominee Information
First Name
First Name is required.
Last Name
Last Name is required.
Is nominee a member of KSHN?
Yes
No
Do not know
Title
Title is required.
Email Address
Email is required.
Invalid Email ID
Phone Number
Phone Number is required.
Invalid Phone Number
Nominee Mailing Address
Street
Street is required.
City
City is required.
State
State is required.
Zip code
ZIP Code is required.
Maximum 5 characters allowed.
Represention
Business
Education
Government
Labor
Please provide a brief summary of nominee qualifications: