Fermilab Community - ILC Task Force Nomination Form

Fermilab Community Task Force on Public Participation

International Linear Collider Citizens Task Force Membership Nomination Form

Nominations may be made by completing and submitting the interactive form below or by printing and faxing a hard copy. All nomination forms must be received by the Fermilab Office of Public Affairs by December 6, 2006. Any questions, please call 630-840-3351.

ILC Task Force Fact Sheet (pdf)

Proposed ILC Task Force Member:

Name Position

Address

Phone Email

Nominator:

Name

Phone Email

If this is a self-nomination, please provide the name of a reference:

Name Position

Address

Phone Email

Briefly describe why this person is a good candidate for the Task Force:

Briefly identify any background, positions, experience, and community activities that relate to this person’s qualifications and perspectives:

Note: if you are nominating someone else to serve, please be sure to contact that person to notify them of the nomination and verify the person’s interest in serving.