WIPP Leadership Advisory Council Application

In addition to completing this application, please send your resume and bio to Pam Woo at pwoo@wipp.org.

Email address
Name:
Your answer
Company:
Your answer
Title:
Your answer
Address:
Your answer
City, State & Zip:
Your answer
Phone:
Your answer
Primary Email:
Your answer
Business Website (if applicable):
Your answer
Years in Business or Position:
Your answer
Are you currently a WIPP National Partner Member?
If you are not a WIPP National Partner, are you willing to upgrade to Advocacy Partner level ($500/year)?
NAICS or Industry of Your Business:
Your answer
Average Annual Revenue for Your Company in FY2016:
Your answer
Please indicate if you were referred to the LAC by a WIPP member or friend and share with us their names.
Your answer
Why did you join WIPP?
Your answer
What other business and professional organizations are you involved in?
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Do you have any current or previous board service or leadership roles in professional organizations or charities?
Your answer
What skill sets and/or talents will you bring to WIPP's Leadership Advisory Council?
Your answer
Please share with us how you would like to see WIPP grow in the future and what role you can play in helping achieve that vision.
Your answer
Will you be able to commit to a two (2) year term on the Leadership Advisory Council?
Will you be able to commit to two (2) in-person meetings and two (2) phone meetings per year, including participation in WIPP's annual event?
Are you willing to lead and/or serve on committees?
Please share any possible professional or personal constraints on your time or service.
Your answer
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