*1.Name(Required.)

*2.Phone number(Required.)

*3.Email address(Required.)

*4.Which membership committee(s) would you be willing to contribute to?(Required.)

Membership

Education

Advocacy

Safety

Research

*5.How many hours per MONTH would you be willing to dedicate to committee efforts?(Required.)

1

2

3

4

5

6

7

8

9

10

Variable

6.Briefly tell us how you believe your skills, education, and experience can be used to benefit I-CAPP members: