*	FirstName:
*	LastName:
*	Email Address:
	Home Phone: (512..xxx.xxxx ext ###)
	Other Phone: (512..xxx.xxxx ext ###)
*	Best way to reach you?		Email Home phone Work phone
*	Best time of day?		Morning Afternoon Evening Weekends Anytime
	NSBE Membership Number (optional):
	Mailing Address:
	City: Austin Bastrop Cedar Park Georgetown Pflugerville Round Rock San Antonio Waco other	State: Texas Outside US / Canada Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northern Mariana Is Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Province du Quebec Puerto Rico Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory	Zip:
	How did you hear about AA-NSBE?

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Events/Activities/Meetings

(check all that apply to your volunteer interest and/or provide comments)
(event details)

Additional comments:

Committees

(check all that apply to your volunteer interest and
rank in order of preference if choosing more than one)

Briefly explain why you are interested in the above position(s) and / or
your vision, goals, and objectives.

Please list any experiences for consideration
(i.e. positions, services, work related, other organizations, etc.):

for Committee Chair appointment applications
Early submission deadline:  May 1
Final submission deadline: June 1

Please submit application to AA-NSBE CEB Member. 
For additional questions or to submit the word document: vicepresident@aansbe.org