Name of Candidate: Title:
Agency: Agency Phone:
Direct Phone: E-mail:
Address: ACWA Region: County:
REGION BOARD VACANCY
CANDIDATE NOMINATION
Submit completed form to [email protected]
Agency Function(s)
Check all that apply
Ag Water Supply Urban Water Supply
Flood Control Wastewater Reclamation
Groundwater Management / Replenishment Wholesale
Retailer Other:
Sewage Treatment
Describe your ACWA-related activities that help qualify you for this office:
Write below or attach a half-page bio summarizing the experience and qualifications that make you a viable candidate for ACWA Region leadership. Please include the number of years you have served in your current agency position, the number of years you have been involved in water issues and in what capacity you have been involved in the water community. You may share a candidate photo along with your application. Candidate photos and bios will be shared on the ACWA region election webpage.
I acknowledge that the role of a region board member is to actively participate on the Region Board during my term, including attending region board and membership meetings, participating in region conference calls, participating in ACWA’s Outreach Program, as well as other ACWA functions to set an example of commitment to the region and the association.
I hereby submit my name for consideration by the Nominating Committee. ___________________________________ __________________________________ ________________________ Signa ture T itle Da te
Please attach a copy of your agency’s resolution of support / sponsorship for your candidacy.