MCMC Nomination Form

Mid-Columbia Medical Center BU Nomination Form

To nominate a Mid-Columbia Memorial Center nurse for leadership, please complete the form below.

If you are self nominating, the completion of this form signifies your consent to serve.

Nomination and Consent to Serve Form

Please complete the form below, entering the name of the nurse you would like to nominate.

Please provide your name below.
Vice Chair
Secretary
Treasurer

Name *
Email Address *
Mobile Phone
Self-Nomination
If this is a self-nomination, please complete the following questions.
Unit
ShiftPlease provide a short paragraph sharing why you want to hold the position for which you are applying.
Consent to Serve	YES, I am nominating myself and consent to serve NO, I am only nominating others

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