INF CONSENT TO SERVE Survey

1.PLEASE COMPLETE THE INFORMATION BELOW(Required.)

Name:

Credentials:

Address:

Address 2:

City/Town:

State:

ZIP:

Home Phone:

Preferred Email:

Cell Phone:

2.EDUCATION - highest level of education(Required.)

DEGREE

SCHOOL

3.EMPLOYMENT (Required.)

EMPLOYER

PRESENT POSITION

4.I CONSENT TO HAVE MY NAME CONSIDERED FOR APPOINTMENT/ASSIGNMENT TO THE FOLLOWING POSITIONS.(Required.)

FUND DEVELOPMENT COMMITTEE

EDITORIAL COMMITTEE

5.Please give a brief summary of your experience and/or interest in serving in position(s) selected above.

6.If appointed to the INF Board of Directors or Committee it is my obligation to attend meetings and do the work of the position. If I am unable to fulfill this commitment, I will resign.

Upon appointment, I will receive links to the following forms that must be completed prior to the first committee meeting.
1. Board of Directors Confidentiality Agreement
2. Conflict of Interest Policy

Completion of the line below serves as the electronic signature of the individual completing this form.(Required.)

Name:

Date:

INF CONSENT TO SERVE

DEMOGRAPHIC DETAILS