Form for Committee Work & other Volunteer Interest

Nominee’s given name:

Nominee’s family name:

Email:

Phone (including country & area codes):

Fax (including country & area codes):

Full contact address:

Nationality:

Date of birth:

Interest in Volunteer Work in any of the following Areas:

Ambassador/Outreach (Appointed Position)

Communication (Appointed Position)

Congress Oversight (Appointed Position)

ICDC Oversight (Appointed Position)

Membership (Appointed Position)

Business Development (Appointed Position)

Program Services (Appointed Position)

OTHER

Other suggestions of ICF Activity you might consider

Please provide a brief background statement of work history and current work situation (Max : 500 Character):

I agree to meet the obligations as outlined for the position/s indicated above : Yes No

Please attach a photo (head and shoulders) here (Min : 1000 x 1000)(Optional):

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FORM FOR COMMITTEE WORK & OTHER VOLUNTEER INTEREST