NAWIC New Committee Member Nominations and Declarations Survey

1.Personal details(Required.)

First Name

Last Name

State/Territory

Email Address

Phone Number

2.Select your Chapter (must be the state/territory you reside in)(Required.)

3.Membership ID number (You must be a paid NAWIC member)(Required.)

4.Nominee Name (You can enter your own name or another members name)

5.For the position of:

Committee Member

Please specify your interests or the committee you wish to join: (eg: events, education, marketing, sponsorship etc.)

6.Have you ever worked in the construction industry?(Required.)

Yes

Job title?

7.Declaration: I confirm that I have read and I agree to abide by the NAWIC Chapter Code of Conduct.(Required.)

Yes - I declare

8.Declaration: I confirm that I am a current member of NAWIC and I agree to abide by the NAWIC Chapter Management Policy and the NAWIC Constitution(Required.)

Yes - I declare

9.DECLARATION OF COMPLIANCE WITH Conflict of Interest Policy:

I am advised that it is the policy of NAWIC that, as a matter of routine when making a board or chapter committee appointment, NAWIC must be satisfied that there is nothing in the personal or financial affairs of potential appointees which, if made known publicly, would be of embarrassment to either NAWIC or the appointee, and nothing that would compromise the real or perceived integrity of NAWIC decision making.

I wish to advise that, to the best of my knowledge, my private and financial interests including taxation affairs would not conflict with my NAWIC duties or otherwise cause embarrassment to NAWIC decision making, or influence, or appear to influence, the proper consideration or decision making on a matter.

I understand that, if I wish, I may discuss this matter with the National Chair prior to making this certification.

I undertake to have regards to the requirements of NAWIC regarding disclosure of interests and to bring to the attention of the Chapter President any such issues which may arise.

I understand that this declaration, once completed, will be retained and included in the NAWIC Register of Interest.(Required.)

Yes (Please type 'I declare')

Please include any conflict of interest you wish to declare:

Please sign (Type your fullname)