Committee Application

Committee members are required to be AAERT members in good standing.

First Name *

Last Name *

Email *

Company Name/Employer *

Position(s) *

If you have industry certifications, please list them here.

On which committee(s) would you like to serve? *

You may list up to three committees in order of preference.

Please share your current and past involvement on other boards and committees.

Why are you interested in the committees you listed and what relevant skills and/or experience would you bring to this work?

How many hours per month (average) are you willing to commit to committee work and meetings? *

Please indicate # of Hours / Month

Please list any potential conflicts of interest with the work of the committee(s) you have listed which may arise from your personal or financial interests or those of your businesses.

Are you willing to sign annual conflict of interest statements and confidentiality agreements pertaining to your work on an AAERT committee? *

Yes No