IPEIA Committee Members

Name *

First

Last

Email *

Phone *

Company

Title

Address

Why do you want to be an IPEIA Committee Member? *

Are you able to commit to the number of estimated minimum 8-12 volunteer hours per month? *

Yes
No

Please list your past and current volunteer commitments (organizations, roles you held, references, etc) *

Are you able to start immediately (IPEIA’s annual cycle is April through March)? *

Yes
No

Does your organization support your volunteerism?

Yes – my company has asked me to represent them
No – I am volunteering on my own time

If your commitment with IPEIA is part of your performance evaluation, please request your manager to contact IPEIA to arrange this discussion with the appropriate representative for feedback (admin@ipeia.com).