PIIAC's Next-Gen Committee - Interest Form
The Next-Gen Committee nurtures insurance professionals, newcomers and seasoned professionals alike, by fostering essential skills for success. Through personalized education plans, we tailor support to your individual needs, helping you refine your expertise, elevate your professionalism, and walk away empowered to make a lasting impact in the industry. Please fill out this interest form if you would like to join the community/receive communication regarding the creation of the committee.
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Full Name
*
First Name
Last Name
Email
*
example@example.com
Cell Phone Number
Company
*
Supervisor's Full Name
First Name
Last Name
Supervisor's Email
Are you interested in holding a leadership position within the committee?
Yes
No
How much time per month can you commit to the committee?
>5 hours
5 - 8 hours
8 - 10 hours
10+ hours
Do you know anyone else who may be interested in joining the committee?
Yes
No
If yes, please include their names and email addresses.
I am interested in volunteer opportunities within my community.
Yes
No
I am interested in opportunities for CE/Professional Development within the committee.
Yes
No
I would be interested in attending a political awareness seminar hosted exclusively for committee members.
Yes
No
What kind of events and community service projects would you be interested in participating in?
What do you hope to get out of joining PIIAC's Next-Gen Committee?
Submit
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