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1. QUALIFICATIONS OF APPLICANT
a. Attach separate statement resumé providing evidence of your general knowledge and competence in the scope (work) of the committee.
b. What is your specific relationship to one or more elements of the scope of the committee?
c. Will you be able to actively participate in the work of the committee including responding to correspondence and attending committee meetings?
2. REPRESENTATION
a. Indicate below the name of the entity you would be representing and include written authorization from that entity authorizing you to be their representative:
b. Does the organization you would represent have a mechanism for instructing votes? If so, can the time constraints imposed by the Policies and Procedures IAPMO PP-1 and/or IAPMO PP-2 be met?
3. FUNDING SOURCE(S) FOR YOUR PARTICIPATION
a. What person(s) or organization(s) would fund your participation as a committee member, either in whole or in part? (You should list your employer if your participation is funded by your employer or if your participation is part of your employment responsibilities or otherwise related to your employment.)
b. Background and description of your employer and/or other person(s) or organization(s) funding participation:
4. ADDITIONAL COMMENTS
Languages, other than English:
COMPLETE A SEPARATE APPLICATION FORM FOR EACH COMMITTEE ON WHICH YOU DESIRE TO SERVE. IN ORDER TO
ASSURE THE PROMPT PROCESSING OF YOUR REQUEST, PLEASE BE SURE TO COMPLETE ALL QUESTIONS AND SIGN
THIS APPLICATION.
INTEREST CATEGORIES
(a) Producer (Manufacturer) Interest - this category includes those who are predominantly involved in the manufacture, promotion, retailing, or distribution of the subject products, materials, or services (e.g., manufacturers, distributors, licensors, developers, associations of any of these groups, and professional consultants to any of these groups).
(b) User Interest - this category includes those who are subject to the provisions of the standards or who voluntarily use the standards (e.g., testing laboratories, certification bodies, regulatory agencies, and standards developing organizations).
(c) General Interest - this category includes those who are neither producers nor users (e.g., academics, consumers, contractors and subcontractors, construction labor organizations, educators, researchers, and technical societies).
Note: Individuals retained as consultants under an indefinitely continuing agreement with an organization shall be categorized in accordance with the category of the retaining organization.
If appointed, I agree to abide by the rules and guidelines of IAPMO. In addition, I hereby agree to notify IAPMO
of a change in status, including change of employment, organization represented, or funding
source. I also agree that IAPMO shall have, and I hereby grant, all and full rights in copyright in any material that I
author, either individually or with others, as a member of this committee, or that I submit for the proposed use of the
committee in an IAPMO code or standard or other IAPMO document. I further acknowledge that I acquire no rights in
any publication of IAPMO and that copyright and all rights in all materials produced by IAPMO technical committees are
owned by IAPMO and that IAPMO may register copyright in its own name.
I do not now hold and I do not intend to hold any patent, the use of which would be required for compliance
with any material that I author – either individually or with others – as a member of this committee, or that I
submit for the proposed use of the committee in an IAPMO code or standard or other IAPMO document.
I attest that all of the information on this application is true and accurate.
By signing below, I attest to my ability to communicate with IAPMO staff and the members of the
Technical Committee through electronic means, namely via e-mail and the internet.
Date: 2019-12-09
Signature
Your typed name above constitutes your electronic signature.
If you have an attachment, upload it here:
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