Committee & Task Force Application

Committee & Task Force Application

Complete the application and, if applying for Policy Making Committees, include your required Statement of Qualifications.
Applicant Information
Full Name

First NameLast Name
Date

MonthDayYear
Date
Office / Brokerage
Agent Cell Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Are you a:
What Association if your Primary AOR:
Preferred Method of Contact
What is (are) your area(s) of expertise?
Prior Committee Service (include committee name and dates of service)
Section 1 — Task Forces
Task Forces

Most Task Force assignments are short-term and usually completed in 2–3 meetings; we believe short-term tasks are easier for our members to participate in. Task Forces marked with an asterisk (*) meet on an ongoing basis throughout the year. By choosing a Task Force below, you may be called to serve on a particular task. Check each Task Force you would like to serve on.
Please let Lauri know that I am interested in chairing of one of the task force (s) that I have signed up for.
Section 2 — Policy Making Committees
Policy Making Committees
Please let Lauri know that I am interested in chairing of one of the policy making committee (s) that I have signed up for.
If you selected one or more Policy Making Committees above, you must complete the section below. Describe your qualifications, relevant experience, and any specialized knowledge or training that prepares you to serve on the committee(s) you selected. Applications for Policy Making Committees will not be considered without a completed statement.
Statement of Qualifications
Additional Comments
Signature
Should be Empty:

Committee & Task Force Application

Applicant Information

Section 1 — Task Forces

Section 2 — Policy Making Committees