Volunteer for a Committee

Please provide the following information about yourself or the person you wish to recommend. IRA membership is required for committee service and members may serve on only one committee in any given year. Nominations must be received by October 15, 2013.

* First Name

* Last Name

* Home Address

Home Address Line 2

* City

* State

* Zip Code

Home Telephone Number

Office Telephone Number

* E-mail Address

* Confirm e-mail Address

* IRA Membership Number

* Affiliation

* Job role

Please select up to three committees and list your qualifications for each choice. For additional information about the responsibilities of each committee, please go to www.reading.org.

* First Committee Choice:

* Qualifications for first choice

0/255 characters

* Second Committee Choice:

* Qualifications for second choice

0/255 characters

* Third Committee Choice:

* Qualifications for third choice

0/255 characters

Additional Information

* Demographics

Urban

Rural

Suburban

Your race/cultural background (Although not required, the information requested below will help us ensure diversity in our committee membership):

* Please list dates of all IRA committee positions held within the past five years.

* Are you able to attend IRA's annual convention?

Yes

No

* Indicates Response Required

African-American (non-Hispanic)	American Indian or Alaskan native
Asian or Pacific Islander	Caucasian (non-Hispanic)
Hispanic (any race)	Multiracial
Other, please specify