2016-2017 CLMA Committee Volunteer Application 1. Committee Volunteer Application Question Title * 1. First Name: Question Title * 2. Last Name: Question Title * 3. Credentials: Question Title * 4. Current Title/Position: Question Title * 5. Email Address: Question Title * 6. Phone Number: Question Title * 7. How many years have you been a CLMA Member? Question Title * 8. Are you a member of a CLMA Chapter? No Yes (please indicate which chapter) Question Title * 9. Have you served as a CLMA Chapter Board member? No Yes (please indicate how many years) Question Title * 10. Have you served as a CLMA Board member? If yes, please indicate how many years. No Yes (please indicate how many years) Question Title * 11. Have you served as a Committee Volunteer? No Yes (please indicate which committee) Question Title * 12. Please indicate if you would be interested in being added to a volunteer database that may be tapped for future projects or task force work: Yes No Question Title * 13. Please provide a biosketch (no CVs please), not to exceed 300 words, highlighting special professional training, skills, or hobbies that you could bring to a CLMA Committee. The biosketch should also focus on your professional qualifications and strengths. Question Title * 14. Each nominee should submit an interest statement, not to exceed 500 words. The statement should identify and describe why you are interested in serving on a CLMA Committee, what skills you will bring as a member of a Committee, and how you feel you can help strengthen CLMA and its initiatives. Please also indicate that you understand and are willing to commit fully to the meeting expectations and required time demands of a Committee volunteer. Done