Board Self Nomination App

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Board of Directors Self-Nomination Form

Please use this entry form to nominate yourself to be placed on the Board of Directors ballot. To nominate someone else, click here.

* Indicates required field

Your Name *

First

Last

Your Company/Organization Name *

Your Email *

Your Phone Number *

I certify that I am able to make a 3-year commitment, and will be able to attend the Orientation and Interview. *

Yes No Unsure

Please contact the Chamber office if you are unsure about any of the commitment requirements.

Known Qualifications *

Please indicate any committees you have served on and/or chaired, and if you are a Leadership graduate.

Demographics: Age Range *

Demographics: Gender *

Demographics: Race *

White Black or African-American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Other

Demographics: Ethnicity *

Hispanic, Latinx or Spanish Origin Non-Hispanic, Latinx or Spanish

Areas of Expertise *

Administration/Management Computers/IT Entrepreneurship Investments Human Resources Public Relations Real Estate Accounting/CPA Financial Management Government/Politics Law Strategic Planning Tech/Science Banking/Trusts Engineering Fundraising Graphic Design Marketing Physical Plant Website Design

Personal Style and Interpersonal Skills *

Leadership Strategist/Strategic Thinker Challenges the Assumptions Overcomes Adversity Advocate Generalist Tactical Thinker Copes with Risk Taking Thinks Outside the Box Visionary Detailed Conciliator and Bridge Builder Collaborator Problem Solver Planner

Other Expertise (Please Describe) *

Community Connections *

Business Political Community Volunteer Media Philanthropy Civic & Professional Affiliations

Optional: Completed Signature Petition *

Max file size: 20MB

OPTIONAL: Please upload your signature petition completed (with 5% of voting member signatures).

Upload CV/Resume *

Max file size: 20MB

Upload CV or Resume of your nominee, if available.

Submit

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15800 Pines Boulevard, Suite 313 | Pembroke Pines, FL 33027
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