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Member Advisory Committee Application

Please fill out this form if you'd like to join our

First name

Last name

Email

Phone

Street Address

City

State

Street Address Line 2

Zip code

Country

Date of Birth

Gender

Ethnicity

Occupation

How did you hear about the Member Advisory Committee?

What other extracurricular activities are you involved in (sports, employment, volunteering, clubs, etc.)?

Why are you interested in being part of the Member Advisory Committee?

What unique perspective will you be able to offer if selected to participate on the Member Advisory Committee?

Your Signature

Thank you! We’ll be in touch.

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