NWMOA Member Committee “Willingness to Serve” Form MemberSalutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*Suffix (i.e. Ph.D., P.E., Jr.)Job Title*Company*Mailing Address*City*State/Province*ZIP/Postal Code*Country*Telephone*Cell phoneEmail* Email Notifications*Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Authorization for receiving publication email notification from NWMOA. (applies to all email addresses on this form)Website I hereby affirm that:• I am a NWMOA Member and interested in serving on a Committee; • If approved by the NWMOA Board, I am willing to serve at least one year on the Committee. My preference for NWMOA Committees will be marked below.• If approved, I am willing and able to participate in monthly Committee meetings either in person or via conference call, and follow through on action items as assigned; • I understand that if approved, I should expect to volunteer at least 2 hours per month to fulfill my Committee duties (committee participation, write Committee articles for quarterly newsletter and other assigned action items); • I understand that I must maintain active NWMOA member status in order to serve; • I will complete the Biography below for the Board’s consideration; • I understand that the submission of my name to the Board for consideration does not guarantee a place on a Committee; • If approved, I will provide a photo as a jpg image for the NWMOA website and/or publications within five business days of notification of selection.* I agree to all of the above terms and conditions Awards Regulatory Membership Operator Certification Publications/Newsletter Program/Technology Transfer Public Relations/Social Media Biography Photo for NWMOA websiteAccepted file types: jpg, png, pdf. Biography*Please provide one paragraph – 150 words or less. Comments and CaptchaQuestions/CommentsCaptchaPlease enter the letters displayed above to complete the form and then click Submit.