IACR 2001 Election Nomination Form

Section 1 --- to be completed by nominator ---

I nominate _______________________________ for the position of IACR _________________ .

Nominator:

__________________________________________ __________________________________________
Name (print) Signature
__________________________________________ __________________________________________
Date Address
__________________________________________ __________________________________________
Email Address
__________________________________________ __________________________________________
Fax Address

Section 2 --- to be completed by nominee ---

I, ___________________________________________________, accept this nomination.

Candidate's statement (max. 50 words, may also be sent by email):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Optional items to appear only in the electronic version of candidate statements:

Nominee:
__________________________________________ __________________________________________
Name (print) Signature
__________________________________________ __________________________________________
Date Address
__________________________________________ __________________________________________
Email Address
__________________________________________ __________________________________________
Fax Address

This form must be received by mail or fax by September 16, 2001 at the address below. Receipt will be acknowledged by email. 

Tom Berson
Anagram Laboratories
P.O. Box 791
Palo Alto, CA 94302, USA
Fax: +1 650 324 0120
(Previous versions of this document listed Kevin McCurley's address here, but this supersedes all previous versions.)