ENVIRONMENTAL AND WATER RESOURCES INSTITUTE (EWRI)
GOVERNING BOARD NOMINATION FORM

ATTENTION: All completed nomination packets must be received at EWRI by 5pm Monday, January 26, 2009.

CONTACT INFORMATION
First Name:
Last Name:
EWRI or ASCE ID:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
EMPLOYMENT INFORMATION
Employer:
Job Title:
Employer's Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Educational Background (degrees and dates)
EWRI/ASCE PARTICIPATION
Current Committee/Council: Awards Climate Change Communications Education & Research Emerging & Innovative Technology TC Environmental Ground Water History & Heritage Hydraulics & Waterways International Irrigation & Drainage Planning & Management Section & Branch Activities Standards Students & New Professional Activities Water, Wastewater & Storm Water Watershed Urban Water Resources Research
Other EWRI or ASCE Council or Committee(s): (list Council, committees and positions held)
ASCE Section/Branch Activities: (list Sections, Branches, Committees, and positions held)
Professional Licenses:
Other Professional Affiliations and Leadership:
Signed by: