Please use this form if you are applying to be considered for a PARMA Steering Committee position for the first time. Your application will be reviewed by the PARMA Board of Directors. Full Name - Please include any applicable designations. * Title * Employer * Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Postal Code * Email Address * Telephone Number * Fax Number Description of your Job Duties * Statement of Goals and Objectives as a Steering Committee Member * PARMA Chapter * Bay Area Central Coast / South Bay Central Valley Gold Coast Sacramento San Diego/Imperial Valley Southern California Affiliated Organizations * List all work affiliated organizations on which you serve as either a board, committee or officer. Mail Copy to Email Address If you would like a copy of this form for your records, please enter your email address here. Leave this field blank