Nomination Form For The Fire Island Pines, Inc. Board Of Directors

I, the undersigned, wish to nominate the following named Co-op Shareholder for an open position on the Fire Island Pines, Inc. Board of Directors for a term of two (2) Years. The below named person has given permission to submit his/her name, and has agreed to serve on the Board if elected by the membership at the Spring Shareholders Meeting. Deadline for submissions is May 1, 2018.

Nominee's Name

First Name

Last Name

Nominee's Unit Number

Complete the following biographical data which will be used on the ballot mailed to all Shareholders:

Nominating Shareholder's Name

First Name

Last Name

Nominating Shareholder's Unit Number

Nominating Shareholder's Email Address

Date

YYYY

Board Nomination Form

Nomination Form For The Fire Island Pines, Inc. Board Of Directors

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