* 1. I am interested in being a member of the Anschutz Medical Campus Faculty and Staff Multicultural Affairs Committee

* 2. I am a...

* 3. Title and department

* 4. I would like to receive information about the monthly meetings

* 5. The second Tuesday of each month meeting at (12:00) noon is appropriate

* 6. If No, select another time

* 7. Tuesday is an appropriate day

* 8. If No, select another day

* 9. What week of the month should the meeting be held

* 10. Should all meeting be conducted in a Business Meeting Format

* 11. If No, select another Meeting Format

* 12. Select choice of flexible Meeting Format

* 13. I would like to participant in the following sub-committee

* 14. I am interested in a leadership role on this committee

* 15. I am willing to serve as the...

* 16. What else would you like to see this committee do...

* 17. Please provide your contact information

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