IAPMO

IAPMO Innovation Task Group Membership Application

Task Groups are not required to be balanced by interest and the Task Group shall be discharged at the conclusion of the task. The schedule anticipates 2 meetings, to be conducted via teleconference and web meeting. It is not anticipated that in-person meetings will be convened for the development of the Task Group. However, if travel is required, meetings will be held at IAPMO Headquarters, 4755 East Philadelphia Street, Ontario CA 91761. Instructions for completing this form:

  1. Read each section carefully before completing.
  2. Tab through to get to a new section of the form.
  3. Fill in the form completely. DO NOT LEAVE BLANK SPACES. If a section does not apply to you, indicate "N/A" (not applicable) or, if you need more room than is allowed, you may attach a separate sheet of explanation as a "Word" document or in PDF format.
  4. If you are applying as a representative to an organization, you will need to supply a letter of authorization. It must be submitted on the organization’s letterhead and signed by an officer of the organization. You may fax this document to IAPMO at 909-472-4246. Your fax cover sheet/transmittal sheet should indicate that you are/have submitted your application online, including the date submitted. This letter may also include information requested in Section 3, parts (a) and (b). The following is a SAMPLE of suggested wording for the authorization letter.

    SAMPLE: We, (organization’s name), authorize (your name) as our representative to serve on the Task Group. We will support (your name) for his/her time and travel expenses during his/her service as a member of the Task Group.

  5. Review the form for accuracy before submitting to IAPMO.

Please contact IAPMO by phone at 909-731-0219, or by e-mail at christoph.lohr@iapmo.org if you have any questions about this form.

Note: At this time, participation is anticipated to be virtual only.

 

Name
Title
Employer
Mailing Address
UPS or Other Mailing Address
City
State
Zip Code
Telephone
Fax
Email
The task group you are applying for:
Medical Gas Resiliency Task Group
Bathroom Design Task Group
Water Demand Calculator Task Group

Please indicate the interest category which you believe best suits your qualifications:

Manufacturer
User
Installer/Maintainer
Research/Standards/Testing Laboratory
Enforcing Authority
Consumer
General Interest

Are you interested in serving as Chair to the Task Group? The Chair is responsible for running the task group meeting.
Yes
No

1. QUALIFICATIONS OF APPLICANT
a. Attach separate statement resumé providing evidence of your general knowledge and competence in the scope (work) of the Task Group.

b. What is your specific relationship to one or more elements of the scope of the Task Group?

c. Will you be able to actively participate in the work of the Task Group including responding to correspondence and attending Task Group meetings?

2. REPRESENTATION
Indicate below the name of the entity you would be representing and include written authorization from that entity authorizing you to be their representative:

3. FUNDING SOURCE(S) FOR YOUR PARTICIPATION
a. What person(s) or organization(s) would fund your participation as a Task Group 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:

Languages, other than English:

COMPLETE A SEPARATE APPLICATION FORM FOR EACH TASK GROUP 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) Manufacturer: A representative of a maker or marketer of a product, assembly or system, or portion thereof, that is affected by the standard (e.g., manufactures of particular products and association of manufacturers).
(b) User: A representative of an entity that is subject to the provisions of the standard or that voluntarily uses the standard (e.g., educator, skill-trade trainer, skill trades person and academia).
(c) Installer/Maintainer: A representative of an entity that is in the business of installing or maintaining a product, assembly or system affected by the standard (e.g., contractors, subcontractor, and construction labor organization)
(d) Research/Standards/Testing Laboratory: A representative of an independent research organization; an organization that develops codes, standards or other similar documents; or an independent testing laboratory (e.g., code development organizations, certification agency, testing laboratory).
(e) Enforcing Authority: A representative or an agency or an organization that promulgates and/or enforces standards (e.g., regulatory agency, inspectors and enforcers).
(f) Consumer: A person who is, or represents, the ultimate purchaser of a product, system, or service (e.g., end user of a product and distributor).
(g) General Interest: A person or organization interested in the products or standard addressed by the Committee, who is qualified to serve on the committee, and who does not fall under the other categories (e.g., consultants, special experts, or engineers).

Considerable effort, devotion and hard work will be expected of each Task Group member. Task Group membership carries an obligation to participate actively in all work of the Task Group including the contribution and generation of information, prompt reply to draft reports and ballots, attendance and participation at Task Group meetings and prompt completion of assigned tasks. The undersigned hereby agrees to notify the International Association of Plumbing and Mechanical Officials of a change in any of the information provided in this application including a change in the organization represented, source of funding or employment. The undersigned agrees to abide by the rules and policy of the International Association of Plumbing and Mechanical Officials. The undersigned attests that the information provided in this application for Task Group membership is true and accurate.

The undersigned hereby agrees that his or her authorship contributions to IAPMO in connection with work performed as a member of an IAPMO task group are considered to be works made for hire for IAPMO. To the extent that the undersigned retains any rights in copyright as to such authorship contributions, the undersigned hereby grants and assigns to IAPMO all such rights. The undersigned understands that he or she will have no rights in any IAPMO publications that use such contributions by the undersigned and certifies to the best of his or her knowledge that such contributions are not protected by the copyright of any other person or entity.

By signing below, I attest to my ability to communicate with IAPMO staff and the members of the Task Group through electronic means, namely via e-mail and the internet.

Date: 2021-10-19

Signature

Your typed name above constitutes your electronic signature.