Expression of Interest – Member’s Committee

Please read the Member’s Committee and Selection Criteria before proceeding. Click here to read this document.

Name*
Prefix First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Briefly describe your skill set:
Demonstrated relevant skills and experience:
Are there any other attributes that you would bring to the Committee?
Please tick the below box to agree to the MC commitment and selection criteria*
I agree to the MC commitment and selection criteria.