* 1. First Name

* 2. Last Name

* 3. Title

* 4. Organization

* 5. Type of Organization

* 6. Phone Number

* 7. Preferred Email Address

* 8. Business Address

* 9. Area of Expertise

* 10. Were you referred by anyone?

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

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

* 13. How can you support MEWDC Meetings?

* 14. Committee Support

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

* 15. Assist with informal taskforce

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

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

* 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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