Area of Interest*Check all boxes that are of interest to you. Board Membership Serving on a Workgroup Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code Preferred PhoneCan you receive text messages yes no Alternate Phone Number (if applicable)Can you receive text messages at the alternate number? yes no Email* Please tell us about your interest in serving on the ERI Board.What contributions do you believe you would make as an ERI Board Member?Please share some of your background and experience including any specific knowledge, interests and expertise that you have that could relate to ERI’s mission.ExperiencePlease list any boards and committees that you serve or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social). Click the + sign to add to your list.OrganizationRoleDates of Service Skills, Experience and Interests(Please check all that apply) Disability Related Experiences Employment and Employer Relationships Education Finance/Accounting Fundraising Legal or Legislative Management/Organization/Administration Marketing/Public Relations Outreach Other If Other, please explainThank you very much for your interest.CommentsThis field is for validation purposes and should be left unchanged.
