NERUCA Committee Membership Form
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Email *
Full Name *
Phone Number *
Organization / Company Name *
Current Job Title
 *
Member State *
Please select the state you live in.
Committee Preferences *
Required
Why are you interested in joining this committee? *
Relevant Experience or Skills: Tell us about any experience or skills that make you a good fit for this committee. *
Availability: How many hours per month can you dedicate to committee work? *
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