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* 1. Personal Data

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* 2. Position/Title

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* 3. Business Address

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* 4. Business Phone

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* 5. Sponsoring Business or Organization (if applicable)

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* 6. Contact /Title with Sponsoring Organization

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* 7. Contact's Business Phone/Email

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* 8. Contact's Business Phone/Email

BACKGROUND
Email a copy of your resume or CV, including a brief description of your current responsibilities to info@eastcountychamber.org

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* 9. Complete the following statement:
I consider my most important career achievement to be....

PROFESSIONAL, CIVIC, AND PERSONAL INVOLVEMENT

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* 10. List notable activities, programs, and events in which you have participated during the past five years. Include any offices held, certificates earned, and awards or recognition received.

OBJECTIVES FOR PARTICIPATION

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* 11. Describe what you expect to gain from the program and how you anticipate using the experience in your professional, civic, and personal life.

AREAS OF INTEREST

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* 12. Identify several current issues and opportunities within the East County region and expand on the one that most interests you. 

REFERENCES

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* 13. Provide the names and contact information for two or more professional and/or personal references with knowledge or your qualifications who may each be contacted by the program Steering Committee.

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