Libby Area Technical Assistance Group (LATAG) Board Candidate Form


Libby Area Technical Assistance Group, Inc. (LATAG) members of the Board of Directors are solicited, for nomination to be elected, because of their leadership ability, communicative skills, and because they represent one or more sectors of the community who want to ensure satisfactory EPA Superfund site remedial action through involvement, participation and oversight.  Duties as a Board Member, among others include willingness to act as liaison between LATAG, the public, and any organization in which they actively participate.

 

NOTE: ALL questions MUST be answered.  If the question is not applicable, or you wish not to answer you must state so!

* Required fields
Name *
E-mail Address *
Home Street Address *
Home City *
Home State *
Home Zip *
Home Phone *
Business Street Adress *
Business City *
Business State *
Business Zip *
Business Phone *
Areas of Interest/Expertise *
Other Boards on which you served or currently are serving *
Community activities in which you have been involved *
Reason for wanting to serve on board *
Signature (Typing your name in this space constitutes your signature. You may be asked to sign again to formalize your signature.) *
Date *

I have read and agree to the Privacy Policy *

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Last Updated: October 28th, 2011

Webmaster:
Lubomira Dvorakova - webmaster@LATAG.org

Supervised by:
Phillip Erquiaga, LATAG Board Member, Communications Committee Chair. -
Phillip@LATAG.org

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