Nominate a Board Member

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About the Nominee

Thank you for your nomination. All nominees should be aware that they are being nominated for the Impact Health board.

The Nominee:

Nominee's Full Name

Nominee's Business Name

Nominee's Address

Nominee's Business Address

City

Zip

Nominee's Present Occupation

Nominee's Best Contact Number

Nominee's Email

Major Strength(s) Warranting Nomination

Contact details for the person or organization submitting the nomination:

NAME OF REFERRING PERSON OR ORGANIZATION

phone

Address

Alternate Phone

City

Zip

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To reach Impact Health’s office, contact us at
833-614-9400 or [email protected].

For media inquiries, please contact Jennifer Caldwell at
[email protected].

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