ADDITIONAL ORGANIZATIONAL DELEGATE FORM

This form is to be completed for each person who will represent your organization on the National Forum (other than the voting delegate).

*Please Complete a Seperate Form for Every Individual Representing the Organization*

Name: City: Title:   

  Address (cont):   

Country:    Representative Organization:    

Address:       

  

    State:     

      

Zip:          

Telephone:    

    Fax:        

E-mail: Name:   

E-mail:  

 

Staff Assistant Information (if applicable):     

Please select up to three. National Forum members are encouraged to participate in at least one Implementation Group or Committee.  

 

 

 

Based on the background information you have received regarding the National Forum, which of the following Implementation Groups or Committees would provide the best match for your skills, expertise and/or interests?  

Areas of Potential Interest:     











   

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

   

**To complete your application, send your curriculum vitae or resume to fberrier@danya.com If you have any questions, Faith can be reach at 404/604-2729. Please remember to click the Submit button.**

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