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* 1. Name:

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* 2. Firm

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* 3. Title

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* 4. Email

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* 5. Phone Number

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* 6. City

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* 7. State

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* 8. Link to Linked In profile

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* 9. Please select your current local group:

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* 10. I would like to be considered for the Local Steering Committee position(s) of:

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* 11. Why are you interested in the Local Steering Committee role you’ve indicated, and what specific contributions do you feel you can make?

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* 12. Please describe your experience, holding leadership positions in another professional, trade, civic or charitable organization(s), aside from LMA. How did you personally contribute to the organization’s achievement of its stated goals/objectives?

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* 13. What qualities, skills and traits do you possess that would make you an effective LMA Local Steering Committee member?

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* 14. How has your LMA membership and participation in the community contributed to your professional effectiveness?

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* 15. Please list your recent LMA volunteer experience (last 3-5 years) at the International, Regional, or Local levels.

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* 16. Please list threereferences that the committee may contact for additional information. The committee might also check additional references not listed below.

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* 17. I have read and understand the duties and obligations of the LMA Local Steering Committee role for which I am applying, have discussed the duties and obligations with my employer, and am confident that I can fulfill all such responsibilities. 

SIGNATURE OF NOMINEE

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* 18. Date

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