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