Board of Directors Application

Name(Required)

First Name Last Name

Title(Required)

Company(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Why do you want to be on the CIWA Board?(Required)

How long have you been a member of CIWA and how have you been involved in the Association?(Required)

Have you served on a Board or committee for another industry association? If so, explain what other committees or positions you served on and in what capacity.(Required)

Please provide any information about yourself that you feel could conflict with your ability to serve on the CIWA Board.(Required)

What is your vision for the Association?(Required)

What position(s) and/or committee(s) are you most interested in?(Required)

Who recommended you to the Board of Directors?(Required)

I acknowledge that the following are expectations of all Directors on the CIWA Board and that if selected, I can commit to the time required of the position: