2009-2010 Committee Choice Form

* Email Address

* First Name

* Last Name

Position/Job Title:

* Library/Organization:

* Mailing Address

Address Line 2

* City

* State

* Zip Code

Phone Number

Cell or Home Phone Number

Fax:

* This address is:

Library/Work

Home

* First Choice for Committee Appointment

* Second Choice for Committee Appointment

* Third Choice for Committee Appointment

Additional information about my committee appointment(s):

How many committees do you wish to serve on?

1

2

3

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

Yes

No

This is my first NJLA Committee appointment:

Yes

No

* 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

* Indicates Response Required