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*
Company*
Email*
example@example.com
Phone Number*
Company Position/Title*
If Company Position/Title is 'Other', please describe.
Primary Division*
As listed with ATSSA
Interested in (Select all that apply)*

ATSSA Board of DirectorsATSSA Operating CommitteeATSS Foundation Board of DirectorsGovernment Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment CouncilInnovation CouncilMember Engagement CommitteeOperating CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeSHSP CouncilSign CommitteeTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety Council
Individually Active with ATSSA (Year Started)*
Year started
Individually Active with Road Safety Infrastructure (Year Started)
Year started
Company Business Role*
If Company Business Role is 'Other', please describe.
Areas of Expertise/Experience*

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
Committees/Councils Served (Select all that apply)*

Chapter Presidents’ CouncilGovernment Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment CouncilInnovation CouncilMember Engagement CommitteeOperating CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeSHSP CouncilSign CommitteeTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety CouncilNone of the Above
Committees/Councils Lead: Defined as Chairman, Vice Chairman, Secretary (Select all that apply)*

ATSSA ChapterChapter Presidents’ CouncilGovernment Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment CouncilInnovation CouncilMember Engagement CommitteeOperating CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety and Public Awareness CommitteeSHSP CouncilSign CommitteeTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety CouncilNone of the Above
Other Association Volunteer/Participation (Select all that apply)*

ATSSA ExpoATSSA MidyearCommittee Working Groups/TaskforcesFoundation EventsLegislative Fly-In
Current Leadership in Other Industry Association*

YesNo
If yes, provide Industry Association name
Past Leadership on Other Industry Association*

YesNo
If yes, provide Industry Association name
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
Recommendations / References #1
Full name, organization name, email address, phone number
Recommendations / References #2
Full name, organization name, email address, phone number
Recommendations / References #3
Full name, organization name, email address, phone number
Primary Chapter*
Gender
Race/Ethnicity
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: