Create NSS Nominator Account
NOTE:
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For Organization & Position/Title fields - please enter the Current organization/business you are working for and your Current position/title.
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If Retired, please enter the name of the organization/business you retired from followed by "(Retired)", and your position/title when you retired.
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Please do not use all UPPER or all lower case. Please spell out all acronyms.
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Denotes a mandatory field
Courtesy:
Required
First Name:
Required
Invalid
Middle Initial/Name:
Invalid
Last Name:
Required
Invalid
Address:
Required
Address Cont:
City:
Required
Invalid
State:
Required
Country:
Zip Code:
Required
Invalid US Zip Code
Phone: (###-###-####)
Required
Incorrect Format
Invalid Area Code
Alt Phone: (###-###-####)
Incorrect Format
Invalid Area Code
Email Address:
Required
Invalid email address
Confirm Email
Address:
Required
Emails must match
Alt Email Address:
Invalid email address
Alt Email can't be the same as Email
Confirm Alt Email Address:
Alt Emails must match
Organization Category:
Required
Organization Name:
Required
Position/Title:
Required
Occupation Category:
Required
Seminar Affiliation:
Confirm Password:
Required
Passwords must match