Committee Applicant Information

Your Department Type? *

Career

Volunteer

Combination

Which best identifies your current position? *

Career

Volunteer

Active Member of the IAFC? *

Yes

No

Active Member of the Eastern Division? *

Yes

No

Eastern Division State *

County Within the State *

Department Name *

First Name *

Middle Initial *

Last Name *

Suffix

Current Position *

Street Address *

Address Line 2

City *

State *

Zip Code *

Primary Phone Number *

Email Address *

Committee(s) of Interest

COMMITTEES: *

Please tell us why you are interested in serving on the committee(s) that you have expressed interest in? As well, why you would be a well-suited candidate for the committee(s)? *

Committee Application Attestation

Attestation statement *

By submitting this form, I acknowledge that I am requesting to be considered for appointment to a Committee with the Eastern Division of the International Association of Fire Chiefs.

Signature of individual submitting application for appointment to committee for the Eastern Division of the International Association of Fire Chiefs. *

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