Personal Data:

Name: ____________________________________

Address _____________________ City / State ____________________ Zip ______________

Telephone (Home) ________________________________________ Best time to contact

(Work) ___________________________________________________ Best time to contact

(Fax) E-mail address: ____________________________________________

 I am interested in working with the following committees:

__ Awards Committee is responsible for identifying chapter members that deserve recognition for contributing to AMTA and/or the massage therapy profession in an outstanding manner and diligent volunteerism done by an AMTA member in an altruistic manner.
__ Education Committee is responsible for providing educational opportunities for chapter members at chapter meetings and/or as independent educational events.
__ Meeting and Planning Committee is responsible for planning and two conferences per year.
__ Government Relations Committee is responsible for monitoring legislation that might influence the scope and practice of massage therapy and when directed by the board, lead the chapter efforts to effect that legislation.
__ MTAW Committee: is responsible for planning and monitoring Massage Therapy Awareness Week activities and public relations across the state.
__ Membership-Members Committee will oversee all membership outreach and retention programs as well as maintain the initiatives in recruitment and retention.
__ Membership-Schools Committee will oversee all school outreach and retention programs as well as maintain the initiatives in recruitment and retention.
__ Nominations Committee is responsible for collecting a resume from members who are seeking a board or committee chair position and running the election at the Chapter annual meeting at convention.
__ Unit Coordinator is responsible for holding two workshops per year in their unit.
__ I prefer a 1-time project (may last more than one day)         I prefer __ early AM __ mornings __ afternoon __ evening
__ I can be available for a 1-day task                                   __ I would like to work from my home/office __ Yes __ No
I am available for projects __ Mon __ Tues __ Wed __ Thurs __ Fri __ Sat __ Sun

Skills & Talent Assessment:
__ Type             __ File                   __ Stuff & Mail                 __ Other
I am __ Familiar with MS Office            __ Familiar with Excel              __ Familiar with Publisher
I can __ Help with research projects either using the:    __ Website/internet        __ Using the telephone
I can __ Help with writing articles for the newsletter
I have special interest in: __ Organizing events __ Designing forms, flyers
                                            __ Licensing/certification issues __ Advertising/marketing
                                            __ Other: _______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Send to:
Sara Toogood
PO Box 184
Holly Springs, NC 27540
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 Please attach a copy of your resume.