ALAN State Representative Application 2019-20
Thank you for your interest in becoming an ALAN State Representative. Please take a few minutes and read the ALAN State Representative Responsibilities located at
First Name *
Last Name *
2-Letter State Code *
Email Address *
Institution *
Mailing Address *
Member of ALAN since? (Estimate if not sure) *
Please give the name, position, and email address of a reference. *
Have you attended one or more ALAN Workshops in the past 5 years? *
Please indicate that you have read the ALAN State Representative Responsibilities document ( and are willing to perform the duties described. *
Is there anything else you'd like us to know about you?
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