CA IORG Adult application

Application to apply for consideration of becoming either a leader or member of a Statewide Team or Grand Assembly Committee

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* 1. Please select which Team or Committee you are applying for

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* 2. Name 

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* 3. Address - please include City and Zip Code

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* 4. Assembly Name

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* 5. Select form the following - all that apply

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* 6. Please provide information on skills and experience that you would bring to the position you are applying for

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* 7. Please share with us why you would like to be selected for this role

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* 8. Please select the time commitment you are willing to make in serving in this role

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* 9. Do you see areas of opportunity and if so provide a brief recap of your ideas

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* 10. Are you willing to complete all necessary steps to become a CA IORG Certified Chaperone?

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* 11. Do you have any additional thoughts you wish to share with the selection committee?

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