* 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.

In lieu of membership dues, MEWDC members are required to commit to leveraged contributions to assist in furthering the mission and goals of MEWDC. Please indicate in the questions below the leverage contributions you or your organization will provide as a member of MEWDC.

* 13. How can you support MEWDC Meetings?

* 14. Taskforce Support

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

* 15. Assist with informal taskforce

* 16. Other way you can assist taskforce

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

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

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

* 20. Please upload your resume for review.

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