NATIONAL FORUM MEMBERSHIP APPLICATION FOR INDIVIDUALS

This application for Individual Membership provides background information about the individual applicant.  The form will be used to best match individuals with specific Implementation Groups or Committees of the National Forum based on their interests and skills.  

 

  

Name: Country: Address: Organization: Title:         

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

Address (cont): City:   

State:     

 

 

Zip:        









  

Telephone: Fax:   

    

  E-mail:   

  Staff Assistant Information (if applicable):   

 

Name:  

E-mail:        

 

Work Setting:

Which description best characterizes your current or most professional work environment?     

 

 

What specific skills, expertise, and interests do you bring to help advance the work of the National Forum?  

Individual Skills & Expertise:  

 

 

 

 

 

 

 

 

 









  

 

  Areas of Potential Interest:     

 

 

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?  

 

      

       

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                                                      

 

 

 

 

 

                                                                                       

**To complete your application, send your curriculum vitae or resume to fbarrier@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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