Today's Date *

MM

DD

YYYY

This is my: *

First Submission

Update to a Previous Submission

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Are you familiar with Robert's Rules of Order and Parliamentary Procedures? *

Yes

No

Do you have time to prepare for the World Service Conference by attending all committee meetings as needed? *

Attend meetings of the Board of Trustees or World Service Conference Committee, as needed. These meetings are held by Skype conference calls. You will need to have a computer and internet access for these meetings.

Yes

No

Do you have time to serve as a World Service Conference Facilitator? *

The conference will be held over a 5-day period. Your travel days may add an additional day or two.

Yes

No

Reference 1 *

First Name

Last Name

Phone *

(###)

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Reference 2 *

First Name

Last Name

Phone *

(###)

###

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Reference 3 *

First Name

Last Name

Phone *

(###)

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