Applicant Name

Email Address

Mailing Address

Phone Number

Employer

Your Title

Type of Business

Your Education/Degree(s)

Please list boards and committees on which you currently serve or have served. (i.e. business, civic, community, fraternal, political, professional, recreational, religious, social)

Any awards or honors?

How would AMOS benefit from your involvement on a Committee or as a member of the Board of Directors?

Please list any groups, organizations, or businesses for which you could serve as a liaison on behalf of AMOS.

Skills, experience, and interests: (please select all that apply)

AMOS’s goal is to promote diversity, equity, and inclusion. What does it mean for you to have a commitment to diversity, equity, and inclusion? How have you demonstrated that commitment, and how would you see yourself demonstrating it here?

Please tell us anything else you would like to share.