USJC Membership: Nomination Form

The U.S.-Japan Council comprises Council Leaders, Associates and Friends of the Council and supporters committed to the mission of the organization. Included in these ranks are top leaders from major corporations, academia and research, politics and law, as well as entrepreneurs, small business owners and thought leaders.

We encourage our current USJC leaders to help us grow our network by nominating potential USJC members.

Please complete the form below. Thank you for your nomination.

Please click here to see which states are included in each region.

Please note that this form must be completed in one sitting, as information that you input cannot be saved until the form is submitted.

Nominator Information

The nominator must be a current USJC member in good standing.

First Name*

Last Name*

Your Email*

Your Region*

Specify other region

What is your relationship to the nominee?*
(Colleague, friend, community member, etc.)

Information about the nominee

Please submit the following information about the individual you are sponsoring.

Nominee's Title*

Specify other

First Name*

Last Name*

Date of Birth*

Region*

Specify other region

Field/Occupation*

Specify Field

Job Title*

Organization*

Nominee's Preferred Contact Information

Nominee Email*

Street Address*

Address Line 2

City*

State/Province*

Postal/Zip Code*

Country*

This is a:*
Work addressHome addressOther

Phone Number*

Type of Phone Number Provided*

We would like to share member information with members, so please provide either a LinkedIn profile or professional biography below.

LinkedIn URL*
If the nominee does not have a current LinkedIn profile, please write N/A in this field and instead provide a professional biography below (200 words max).

Attach a file*

Please explain why you feel this individual should be considered.*
(Background, experience, employment, community activities, awards, etc.)

Information about the reference

In order to ensure we continue to bring in individuals who support the Council's mission, we ask that the nominator (you) provide at least one current USJC member in good standing other than yourself as reference for the nominee. USJC staff will be reaching out to those listed below to confirm them as references for this nomination.

Can you confirm that this individual is connected to an additional USJC member who can recommend them for USJC membership?*
YesNo

Reference #1 First Name*

Reference #1 Last Name*

Reference #1 Email*

Reference #2 First Name

Reference #2 Last Name

Reference #2 Email

Reference #3 First Name

Reference #3 Last Name

Reference #3 Email

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that by sponsoring this individual, I am accepting the responsibility of ensuring that they become engaged in the USJC community.*
If the previous statement is accurate, please check this box.