ATSSA Volunteer Leadership Application

ATSSA Volunteer Leadership Application
Volunteer Leadership Application

Thank you for your interest in serving as a volunteer for the American Traffic Safety Services Association. You must be a current member of ATSSA to qualify for a leadership position.
Name*
First and Last Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Company*
Company
Company Position/Title*
If Company Position Title is 'Other' please describe
Primary Division*

Guardrail ServicesManufacturing and ServicesPavement MarkingSign ManufacturingTraffic ServicesOther
If Primary Division is 'Other' please describe
Interested in (Select all that apply)*

ATSSA Operating CommitteeATSSA Board of DirectorsATSSA Foundation Board of DirectorsChapter President's Council (CPC)Government Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment (HFST) CouncilInnovation CouncilMember Engagement CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeStrategic Highway Safety Plan (SHSP) CouncilSign CommitteeTemporary Traffic Control (TTC) CommitteeTraffic Signals CommitteeWomen In Roadway Safety Council
Individually Active with ATSSA (Year started)*
Individually Active with Road Safety Infrastructure (Year started)
Company Business Role*

Strategic ManagementFinancial ManagementMarketing ManagementSales ManagementHuman Resources ManagementProduction and Project ManagementProgram and Safety ManagementOther
If Company Business Role is 'Other' please describe
Areas of Expertise (Select all that apply)*

Administration/ManagementFinancial ManagementOrganizational PlanningOutreach/AdvocacyParticipation in Membership Drive ProjectsServing on ATSSA Committees/Councils in a Leadership RoleServing on ATSSA Chapters in a Leadership RoleServing on Councils or Committees at other Industry OrganizationsStrategic PlanningOther
If Areas of Expertise is 'Other' please describe
Committees/Councils Served (Select all that apply)*

Chapter President's Council (CPC)Government Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment (HFST) CouncilInnovation CouncilMember Engagement CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeStrategic Highway Safety Plan (SHSP) CouncilSign CommitteeTemporary Traffic Control (TTC) CommitteeTraffic Signals CommitteeWomen In Roadway Safety CouncilNone of the Above
Committees/Councils Lead: Defined as Chair, Vice Chair, Secretary (Select all that apply)*

ATSSA ChapterChapter President's Council (CPC)Government Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment (HFST) CouncilInnovation CouncilMember Engagement CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeStrategic Highway Safety Plan (SHSP) CouncilSign CommitteeTemporary Traffic Control (TTC) CommitteeTraffic Signals CommitteeWomen In Roadway Safety CouncilNone of the Above
Other Association Volunteer/Participation (Select all that apply)*

ATSSA ExpoATSSA MidyearCommittee Working Groups/Task ForcesFoundation EventsLegislative Fly-InNone of the Above
Current Leadership in other Industry Association(s)*

YesNo
If 'yes', provide Industry Association(s) name
Past Leadership on other Industry Association(s)*

YesNo
If 'yes', provide Industry Association(s) name
If yes provide Industry Association name
Please briefly describe why you would like to volunteer to serve on a leadership position.*
Please briefly describe why you would like to volunteer to serve on a leadership position
Please briefly outline the specific experience you bring, or contributions you hope to make, to a leadership position.*
Additional Comments
Additional Comments
Recommendations/References
1.*
Full name, Organization name, Email address, Phone number
2.*
Full name, Organization name, Email address, Phone number
3.*
Full name, Organization name, Email address, Phone number
Primary Chapter*
Gender

FemaleMaleNon-Disclosed
Race/Ethnicity

WhiteBlack or African AmericanHispanic or LatinoAsianAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderNon-Disclosed
NonDisclosed
Black or African American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Address street address city stateprovince postalzip code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By entering my signature, I understand that submitting this application does not automatically ensure selection.
Signature*

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