Join an NCSLA Committee!

These committee appointments are for 3 years and will begin June 1. If you have any questions, please contact Dennis Kubasko.

Name

Name Title Mr. Mrs. Ms. Dr.

First Name*

Last Name*

Username

Select A Committee

Please check the appropriate box and complete the related experience question (below) for each committee choice. Choose no more than 2 committees.

Justify Committee Selections

What experience do you have that directly relates to the work of these committees? Please provide justification for each committee you have selected.

Committee Choice 1 (500 chars left)*

Committee Choice 2 (500 chars left)

Preferred Address* Work Home

Work Address

School/Business

Job Title

Address

City

State

Zip Code

Phone

Email*

Home Address

Address

City*

State

Zip Code

Phone

Cell Phone

Email*

Additional Questions

I plan to attend at least one of the NCSLA semi-annual membership meetings.* Yes No

I am currently serving on an NCSLA committee.* Yes No

If yes, which committee:

Term Expires

Educational Exprience: Include present position, dates, and previous positions. (600 chars left)*

Education: Include degree(s) and majors as well as relevant certifications. (600 chars left)*

Other Professional Background Information Relevant to These Committees (600 chars left)*