NWIR Council Application
Is this Council
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New
Merging Existing Councils
Splitting Existing Councils
Inactive
If Splitting or Merging please list existing Councils
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Geographic Area Represented
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Preferred Council Name
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Primary Contact
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First Name
Last Name
Company
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Title
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Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Number
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-
Country Code
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Area Code
Phone Number
Cell Number
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Country Code
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Area Code
Phone Number
Email
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example@example.com
Why do you want to start/reorganize this council?
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Who will be serving as the chairperson of the new Council start-up?
Thank you for your submission. We will be reviewing your information and will get back to you soon!
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