Midwest Energy, Inc.
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Board of Director Nominations Form
Nominee Information
Name:
Address:
City:
State:
Zip:
County Residence:
Length of Residence:
Business Phone:
Home Phone:
Email Address:
Occupation:
Education Information
High School:
Community College:
Business School:
Trade School:
Correspondence School:
College Graduate:
Advanced Degree:
Name of School(s):
College Major:
Activies
Activities - Present:
Activities - Past:
Can you devote approximately 15 days per year to Midwest Energy?
Yes
No
Can you work effectively in group situations?
Yes
No
References
Please list 2 business references with contact name and phone number:
Reference Name 1:
Reference Phone 1:
Reference Name 2:
Reference Phone 2:
By submitting this application I hereby certify that I have reviewed the qualifications to be a member of the Board of Directors of Midwest Energy, Inc. and I meet all of the said qualifications.
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