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* 1. Contact information

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* 2. Requested committee or committees
**Please sign up only for the committees you intend to join and are able to commit to for one hour per month. Your regular attendance is crucial for maximizing your involvement and contribution to these committees.**

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* 3. Please check the box if you are interested in a Chair position.
**Please ensure that you have read and understand the requirements associated with the Chair role**

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* 4. Relevant educational background/certifications/work experience:

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* 5. Statement of your job responsibilities relating to committee(s) named:

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* 6. Special contributions you can make or strengths you can bring to the work of the named committee(s):

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* 7. Why do you want to serve on this/these committee(s)?

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* 8. Do you have the support and approval of your organization's management to meet the commitments and requirements of a PSA committee? 

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* 9. Supervisor Contact Information

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* 10. Have you read the Committee charter as outlined by PSA?

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