* Name: 

* Mailing Address: 

* City:    *State:    *Zip Code:

* Telephone Number:   ()-

* E-mail:

* The best way to contact me: E-mail Regular Mail Phone

* I am applying for:

                General Committee Member Committee Chair

* I am Interested in the following committees:

 (To choose multiple committees, hold "ctrl" while selecting committees)

        Advertising Music Education Recruitment Business (Includes Fundraising) Social Community Service Special Events (e.g. IMPS Model Show, Special Olympics, etc)     

My Special Talents or Interests are:

Ideas I have for Program Board / Student programming are:

* My weekly time commitment to Program Board for fall will be:

                    Less than 5 hours

                    Between 5 to 10 hours

                    More than 10 hours

* Means field is required