Volunteer Leadership Application

ATSSA 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:*
Email:*
example@example.com
Phone:*
Company:*
Company Position/Title:*
If Company Position/Title is 'Other' please describe:
Primary Division:*
If Primary Division is 'Other' please describe:
Interested in (select all that apply)*
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 CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety & Public Awareness CommitteeSign CommitteeStrategic Highway Safety Plan CouncilTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety Council
Individually Active with ATSSA (year started):*
Company Business Role:*
If Company Business Role is 'Other' please describe
Areas of Expertise/Experience (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 Committees/Councils at other Industry OrganizationsStrategic PlanningOther
Committees/Councils Served (select all that apply)*

Chapter President's CouncilGovernment Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment CouncilInnovation CouncilMember Engagement CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety & Public Awareness CommitteeSign CommitteeStrategic Highway Safety Plan CouncilTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety CoucilNone of the Above
Committees/Councils Lead as Chair, Vice Chair, Secretary (select all that apply)*

ATSSA ChapterChapter President's CouncilGovernment Relations CommitteeGuardrail CommitteeHigh Friction Surface Treatment CouncilInnovation CouncilMember Engagement CommitteePAC Oversight CommitteePavement Marking CommitteeRisk Management CouncilRoadway Worker Protection CouncilSafety & Public Awareness CommitteeSign CommitteeStrategic Highway Safety Plan CouncilTemporary Traffic Control CommitteeTraffic Signals CommitteeWomen in Roadway Safety CoucilNone of the Above
Other Association Volunteer/Participation (select all that apply)*

ATSSA ExpoATSSA MidyearCommittee Working Group/Task ForceFoundation EventsLegislative Fly-In
Current Leadership in other Industry Associations:*

YesNo
If yes, provide Industry Association name:
Past Leadership on other Industry Associations:*

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/Reference #1 (include full name, organization name, email address, phone number)*
Recommendations/Reference #2 (include full name, organization name, email address, phone number)*
Recommendations/Reference #3 (include full name, organization name, email address, phone number)*
Primary Chapter*
Gender*

Non-DisclosedFemaleMale
Race/Ethnicity*

Non-DisclosedWhite/CaucasianAfrican AmericanHispanic or LatinoAsianAmerican Indian or Alaska NativeNative Hawaiian or other Pacific Islander
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By entering your name, you understand that your application is to assist the Leadership Committee in their nomination of current and future leadership roles but does not affirm any such appointment.*
Should be Empty:

ATSSA Volunteer Leadership Application