Interest Groups  »  WDS Business Interest Group  »  BIG Participation Application

WDS Business Interest Group Participation Application

1. APPLICANT INFORMATION

Date: (required)
Name: (required)
Address:
City:
State:
Zip:
Telephone: (required)
Fax:
E-Mail Address: (required)

2. INTEREST GROUP INFORMATION
Areas of Interest: (Check all that apply)
   Starting a new practice
   Expanding an existing practice
   Managing an existing practice
   Serving on the WDS Business Interest Group task force
   Providing Business Interest Group content (e.g. Practice tip of the month, Advice for your Policy/Procedure Manual, etc.)
   Host a WDS Business Interest Group networking event

WDS Business Interest Group ListServe: (required)
Would you like to subscribe to the ListServe provided exclusively to WDS Business Interest Group members?
   Yes (Note: your eMail address listed above will be used for your ListServe member account)
   No

Would you consider volunteering as a moderator for the WDS Business Interest Group ListServe?
   Yes
   No

Confidentiality: (required)
Would you like your information to be made available in a Business Interest Group section on the WDS website?
   Yes, allowing the email address on the website for Members-Only (public will not have access to eMail)
   Yes, but do not provide e-mail address
   No

 Would you allow the printing of your Business Interest Group participation information in the printed WDS Directory for members?
   Yes, including my email address
   Yes, without my email address
   No, to any information being placed in the printed membership directory

3. ADDITIONAL COMMENTS & INSTRUCTIONS


PLEASE NOTE: You will receive eMail confirmation of your application