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1. Name:

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2. I am interested in serving on the Committee for the following terms:

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3. Date Certified (CKP Examination Date):

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4. Preferred Email:

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5. Daytime Phone:

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6. Evening Phone:

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7. Best time to contact me by phone:

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8. Years of Paralegal Experience:

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9. Current Employer:

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10. Area(s) of Law:

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11. Please tell us a little about yourself and any special skills you would bring to the Committee (technology skills, organization skills, prior professional association or non-profit experience, etc.):

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12. Do you have any questions or comments you would like for us to consider prior to contacting you?

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