Capital Women's Network (CWN) Nomination
Member Nomination Form
Nominee name *
Names of two (2) nominating CWN members *
List two (2) CWN functions & respective dates Nominee attended  *
Preferred Contact Number *
Only preferred contact number is required, others optional
Nominee telephone number (Personal Cellular)
Nominee telephone number (Work Cellular)
Nominee telephone number (Home)
Nominee telephone number (Business Main)
Nominee email address *
Preferred Mailing Address *
Only preferred mailing address is required, alternate address is optional
Nominee home address
Nominee business address
Nominee Place of Employment *
Nominee Job Title or Profession *
Nominee Job Description *

Current volunteer and community activities and involvement

 *

Recent volunteer and community activities and involvement (past 2-3 years)

 *
Hobbies and interests *
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