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 : *                                             
Preferred address for correspondence :    Work Residence
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, accounting Personnel, human resources Administration, management Nonprofit experience Community service Policy development Public relations, communications Education, instruction Special events Grant writing Fundraising Outreach, 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)