Declaration of Interest Form

Declaration of Interest Form

Non-elected Capacity for a Committee and/or as a Regional Director
Pleae visit www.dmcma.org for more information on commitees and Regional Director positions.
Name*

Last NameFirst Name
Email*
example@example.com
Court*
Position*
Number of years worked in the court system*
Commitee and/or Regional Director Position of Interest (Please check the specific committee or Regional Director assignment desired or complete "Other" to provide a general indication that the applicant is interested in helping the Association wherever is needed)
Committee of Interest

Bylaws & PolicyConferenceCourts Helping CourtsDiversity, Equity & InclusionEducationLegislativeMembershipTechnology
Regional Director

Central (King)Central (East)Central (West)NorthwestNortheastSouthwestSoutheast
Other (interest in helping the Association wherever is needed). Please specify.
- I have read the responsibilities assigned for the position in the DMCMA Policy and Procedure Manual and I'll do my best to implement them.
- I confirm that I don't have any conflict of interest or potential that will be a hinderance in serving on the committee or as a Regional Director.
- I confirm that I will perform my duties as an Executive Board Member by committing to it.
Signature*
Date Signed*

MonthDayYear
Date
Should be Empty: