Georgia Funeral Service Practitioners Association, Inc.

Georgia Funeral Service Practitioners Association, Inc.

Biennial Committee Survey
Member Interest Form

2026-2028
Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Membership Status
Licensee Information
If Licensed please indicate your license number. Ex: FD000 or EMB000
Please select your committee interests. Kindly note that non-licensed members are welcome to serve on committees; however, the role of Chairperson is reserved for licensed members. Every effort will be made to align assignments with your preferences, though specific placements cannot be guaranteed.
Select Committee - (1st Choice)
Leadership - (1st Choice)
Select Committee - (2nd Choice)
Leadership - (2nd Choice)
Leadership will make every effort to honor your preferences; however, selections cannot be guaranteed.
Please share any special skills, professional experience, or areas of expertise you can contribute (e.g., accounting, graphic design, event planning, project management, community outreach, or administrative support). *Optional
Delegate/ Member at Large

GFSPA Delegates are individuals who are not elected to the Executive Board but are recognized as part of the association’s leadership structure. They serve in advisory or representative roles and may contribute to governance, committees, or special projects.
Please select if you are interested in serving as a Member-at-Large.
How many National Conventions have you attended in the past 6 years
Should be Empty:

Georgia Funeral Service Practitioners Association, Inc.

Member Interest Form

Delegate/ Member at Large