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* 1. What is your work email address?

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* 2. What is your name?

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* 3. What is your Agency?

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* 4. What is the best number to contact you at?

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* 5. Which committee are you interested in serving on? Pick Up to 3

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* 6. If interested in the Conference Committee, which event would you like to assist with?

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* 7. Are you interested in being a Chair or Vice-Chair for a committee?

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* 8. Have you ever held a chair or vice-chair position on a committee for VA APCO?

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* 9. Do you have any experience serving on committees at either the state or national level for APCO? If yes, please explain.

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* 10. Do you have any experience with committees from other organizations that you may have belonged or belong to that would benefit our Chapter?

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