Committee Choice Form

Email Address *

First Name *

Last Name *

Position/Job Title:

Library/Organization: *

Mailing Address

Address Line 2

City *

State

Zip Code

This address is: *

Library/Work

Home

Work Phone Number

Cell or Home Phone Number

First Choice for Committee Appointment *

Second Choice for Committee Appointment *

Third Choice for Committee Appointment

Comments or additional information about my committee appointment(s):

I currently serve on the following committees:

How many committees do you wish to serve on?

only 1

up to 2

up to 3

I would like you to contact me about volunteering at events or for special projects.

Yes

No

This is my first NJLA Committee appointment:

Yes

No

Optional: please retype your email address and a copy of this form will be sent to you.

New Jersey Library Association
Box 1534, Trenton, NJ 08607
(609) 394-8032, Fax: (609) 394-8164