Chapter Director Application

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* 1. Contact Information

Name *

Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. IAQA membership is an initial requirement for all prospective Chapter Directors. Are you currently a member of IAQA?

Yes

No

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* 3. IAQ Background (Resume or CV)

PDF, DOCX, DOC file types only.

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* 4. Professional Societies/Trade Organizations Affiliations. Please include name of organization and how long you have been a member.

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* 5. Honors, Awards, Certifications. List any honors, awards, or other certifications you have received, along with the organization and date. You may list up to six (6).

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* 6. Reasons for interest in Chapter

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* 7. Please list your prospective chapter officers and their positions. Suggested positions are Vice Chapter Director, Treasurer, Secretary, and Membership Promotions Chair. If available, please submit their bios or CVs to chapters@iaqa.org.

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* 8. Chapter Petition. Please upload, or submit petition to chapters@iaqa.org.

PDF, DOCX, DOC file types only.

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* 9. By typing my name below, I hereby affirm that the information contained herein and provided by me is true and correct to the best of my knowledge and belief. IF ACCEPTED AS AN IAQA CHAPTER DIRECTOR, I AGREE THAT I WILL ABIDE BY THE BYLAWS, CHAPTER POLICIES, AND OTHER GOVERNING RULES OF THE ORGANIZATION. I also affirm that I have read and understood the Chapter Policies & Procedures in their entirety. I hereby agree to disclose, as stated, any current or potential conflicts of interest to the IAQA Board of Directors and furthermore acknowledge that all listed conflicts of interest will be monitored for compliance and that I must recuse myself from any decision that violates this policy.