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    COMMITTEES APPLICATION
    APPLICANT TYPE


    APPLICANT INFORMATION
    EXPERIENCE
    Please provide work experience relevant to your committee interests from the last 10 years. Format your response as:

    Employer | Title | Years Worked
    Followed by a brief description of your responsibilities and accomplishments.

    If you plan to submit a resume, please note "resume attached" in this section.
    (Optional)
    Provide any additional experience relevant to your committee interests, such as chapter affiliation or other committee involvement.
    COMMITTEE INTEREST
    Please indicate the committee(s) on which you would like to serve.












    PARTICIPATION AND RECOMMENDATION




    CONFERENCE ATTENDANCE

    Provide the last IAPMO conference year and total number of IAPMO conferences that you have attended below:

    Conflict of Interest

    You are obligated to declare any actual or potential conflicts of interest.

    You agree to comply with the rules defined by IAPMO including those related to confidentiality and independence from commercial and other interests.

    You shall declare immediately any prior or present association on your own part, or on the part of your immediate family or employer, with any Applicant, agent, supplier, employee, owner, or member thereof.

    Please declare any entity which could contribute to any potential conflict of interest (Entity Name and Date of Association)

    Notwithstanding this disclosure, it remains your responsibility to bring any actual or potential conflict of interest to the attention of relevant IAPMO staff at the time you become aware of it.

    ACKNOWLEDGEMENT

    If appointed, I confirm my intention that all copyrights in original works created by me in connection or use with my IAPMO Committee service vest with IAPMO and all such works shall be considered as “works for hire” as defined at law. All such work is hereby assigned to and shall be the sole property of IAPMO. 

    I agree to and acknowledge the terms of this agreement, confirm that I am the person named in this application, and affirm that all disclosures made herein are complete and accurate.
    DATA ACKNOWLEGEMENT

    By clicking 'Submit,' you consent to our use of the information you provide in accordance with our Privacy Policy and Terms of Use.

    IAPMO

    AGREEMENT POLICIES

    In the course of your service on an IAPMO committee, you may have access to confidential materials submitted by persons or entities, or
    approval (“Applicants”). This Confidentiality Agreement governs your responsibility with respect to those documents.

    As an IAPMO employee, agent, contractor, subcontractor or committee member you agree to use all confidential information received from any applicant, its directors, officers, employees or agents including, without limitation, any confidential training materials, presentations, curriculum, designs, layouts, or any other confidential business matters relating to applicant (collectively, the "Data"), solely only in connection with the required evaluations to be performed in the course of your service on the committee.

    You shall maintain the Data in strictest confidence and shall not disclose the Data to any person (the term "'person" to be construed to the broadest sense) other than IAPMO unless given the express prior written consent of Applicant or as may be required by any applicable laws or regulations, subpoena from a court of law, or other court order or decree.

    For purposes of this Agreement, the term Data does not include any information which (i) becomes generally available to the public other than as a result of a disclosure by you or IAPMO, (ii) was available to you or IAPMO on a non-confidential basis prior to its disclosure to IAPMO by Applicant, its directors, officers, employees or agents, or (iii) becomes available to you or IAPMO on a non-confidential basis from a source other than Applicant, its directors, officers, employees or agents, provided that such source is not bound by a confidentiality agreement with Applicant or otherwise prohibited from transmitting the Data to IAPMO by an contractual, legal or fiduciary obligation.

    When you serve in this role, you make a commitment to maintain impartiality and avoid bias, including bias that may arise from: self-interest, self-review, advocacy, over-familiarity, intimidation, competition, or other any other source. 

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