1.Name

2.Email address

3.Phone number

4.Region

Northern Michigan

Central Michigan

Southeast Michigan

Southwest Michigan

5.Which of the following committees would you be interested in serving on?

MNPD Strategic Planning Committee

Mentorship Committee

Communications & Outreach Committee

6.Employer (if applicable)

7.Role or Position

8.Why are you interested in serving on the identified committee(s)?

9.What is one idea that you would like to see implemented by each identified committee?