Honorary Advisor Application Form

(For Honorary Board of Advisors of CIA Commission)

Enter Date : *                                         

Enter Full Name (Mr. / Ms. / Dr.) : *   

Residence Address : *                          

Mobile : *                                                            Phone No :    

E-Mail : *                                                 

Employer Name : *                                      Your title : * 

Address : *                                             

Mobile : *                                                            Phone No :    

E-Mail : *                                                 

Preferred address for correspondence :   WorkResidence

Declaration : I hereby declare that the above information is true to my knowledge and I willfully accept this honorary assignment. I also hereby understand that during the course of this assignment I shall not do anything which may harm or tarnish image of the commission. I wish to give my full consent to share my photograph and details wherever required by CIA Commission. I also accept the commission’s code of conduct, terms & conditions, privacy policy and disclaimer as mentioned on the commission’s website – www.ciacommission.org I hereby also agree to the fact that since this is an honorary assignment, it does not involve any financial gains.

I Agree

Place : *     

Please list boards and committees that you serve on, or have served on (business, civic, community, fraternal, political, professional, recreational, religious, social)

1. Organization :              Role/Title :                    Duration of Service :         

2. Organization :              Role/Title :                    Duration of Service :         

3. Organization :              Role/Title :                    Duration of Service :         

4. Organization :              Role/Title :                    Duration of Service :         

5. Organization :              Role/Title :                    Duration of Service :         

Accolades: (Education/Training/Certificates)   

How do you feel CIA Commission would benefit from your involvement on the Board?   

Skills, experience and interests : (Please tick all that apply) *

Finance, accountingPersonnel, human resourcesAdministration, managementNonprofit experienceCommunity servicePolicy developmentPublic relations, communicationsEducation, instructionSpecial eventsGrant writingFundraisingOutreach, advocacy  Other :  

Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of CIA Commission :   

Brief profile description : *   

Photo Attachment : * (Only jpg & png format supported. Maximum file size - 2 mb)

Signature Attachment : * (Only jpg & png format supported. Maximum file size - 2 mb)