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)

    :: India Secretariat Office :: G-26, Chandroday Society, Opp. Golden Triangle, Stadium Road, Navrangpura, Ahmedabad, Gujarat (INDIA)-380014 Ph: 079-4004-9259 (10 Lines) Email: info@ciacommission.org Web: www.ciacommission.org