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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Organization

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* 5. Type of Organization

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* 6. Phone Number

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* 7. Preferred Email Address

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* 8. Business Address

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* 9. Area of Expertise

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* 10. Were you referred by anyone?

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* 11. If you answered yes to the previous question, please indicate who referred you. 

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* 12. Please provide a brief description of any knowledge, skills and expertise qualifying you to serve as a member of MEWDC.

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* 13. How can you support MEWDC Meetings?

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* 14. Committee Support

  Serve on taskforce  Lead taskforce  Ad hoc member - for special projects only 
Career Awareness 
Education

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* 15. Assist with informal taskforce

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* 16. Please explain your commitment to assist with promotion and outreach

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* 17. Please explain your commitment and skills to assist with research and analysis

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* 18. Please indicate any in-kind support or interest you or your organization can provide in regards to Careers in Energy Week

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