Regional Representatives Nomination Form

Full Name: *

Email Address: *

Phone number: *

Company Name: *

Job Title: *

SCTE Member ID: *

Years of SCTE Membership: * Minimum: 3 years required

Biography / Experience Summary: * Include involvement with SCTE, chapters, leadership roles, training, etc.

Describe why you want to serve as a Regional Representative *

What value or perspective would you bring to the role? *

Manager’s Name: *

Manager’s Title: *

Manager’s Email:

Nominator Name (if submitted by someone else)

Nominator Email (if submitted by someone else)