First and Last Name
Home Street Address, City, State, Zip
Phone Numbers - designate home, cell, and/or work
E-mail Address
Check each box to confirm that you understand and agree to the expectations listed in the above documents.
What Division, or Officer Position, most interests you? (select all that apply)
What strengths will you bring to the ITA's Board of Directors? What do you hope to accomplish?
Why does serving on ITA's Board of Directors interest you?
What, if any, has been your past involvement with the ITA, including participation and leadership roles?
Please include your bio below