PTDA Committee Participation Request Form_V2

Please complete the form below to help us identify the best committee volunteer opportunity for you.

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* 1. Full Name:

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* 2. Job Title:

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* 3. Company:

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* 4. Email:

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* 5. Member Type:

Distributor

Manufacturer

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* 6. What is your primary role within your company?

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* 7. What do you like most about your job?

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* 8. What would you like to get out of your experience on a PTDA committee?

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* 9. Please select your committee preference:

Knowledge & Research Committee

Relationships/Community Committee

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* 10. What value do you think you can bring to this committee?

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* 11. Would you like to be considered for a committee task force? Task Forces are project based and only meet virtually.

Yes

No