Application to Indiana Worker's Compensation Institute Board of Directors
Accepting Applications between May 1, - July 16, 2006
Please complete the following information. Note - Application is not complete without emailing your resume to : IWCI President
Candidate's Name:
Telephone: Email:
Have you ever served on the IWCI Board in the past? No answer Yes No
If yes, please indicate year(s) and position(s):
Please express the reason for your desire to serve the IWCI Board and what do you feel you can contribute?
What capacity of service interests you? (check all that apply)
Board Member Committee ChairpersonCommittee Member
Officer Advisor to the board*
(this is a rotating position for associate members with a 2-year term limit)
What impact do you feel IWCI should have on the industry?
