INF CONSENT TO SERVE DEMOGRAPHIC DETAILS Question Title * 1. PLEASE COMPLETE THE INFORMATION BELOW Name: * Credentials: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Home Phone: Preferred Email: * Cell Phone: * Question Title * 2. EDUCATION - highest level of education DEGREE SCHOOL Question Title * 3. EMPLOYMENT EMPLOYER PRESENT POSITION Question Title * 4. I CONSENT TO HAVE MY NAME CONSIDERED FOR APPOINTMENT/ASSIGNMENT TO THE FOLLOWING POSITIONS. FUND DEVELOPMENT COMMITTEE EDITORIAL COMMITTEE Question Title * 5. Please give a brief summary of your experience and/or interest in serving in position(s) selected above. Question Title * 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 Agreement2. Conflict of Interest PolicyCompletion of the line below serves as the electronic signature of the individual completing this form. Name: Date: SUBMIT CONSENT TO SERVE
