Community Resilience Panel Membership Application Form

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Community Resilience Panel Membership Form
Participation Commitment. Two meetings per year and committee conference calls or
virtual meetings at the discretion of the individual committees.
Membership Application. To become a member of the Community Resilience Panel for
Buildings and Infrastructure Systems, please fill out the online form below. If you would
rather not submit your registration online, please complete this form and email it to
[email protected] with the subject “Panel Registration.”
Notwithstanding Statement. This application collects and stores name, address, email
address and telephone number, which the Department of Commerce considers to be
non-sensitive personally identifiable information (PII). NIST will take reasonable
precautions to protect PII transmitted by this application. The transmitted information can
only be compromised as a result of theft, fraud, or other illegal activity. If you do not wish
to accept this risk, please contact [email protected] to submit your
membership application.
This collection of information contains Paperwork Reduction Act (PRA) requirements
approved by the Office of Management and Budget (OMB). Notwithstanding any other
provisions of the law, no person is required to respond to, nor shall any person be
subject to a penalty for failure to comply with, a collection of information subject to the
requirements of the PRA unless that collection of information displays a currently valid
OMB control number. Public reporting burden for this collection is estimated to be 15
minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any
aspect of this collection of information, including suggestions for reducing this burden, to
the National Institute of Standards and Technology, Attn: Steven Cauffman, 100 Bureau
Drive, Mailstop 8615 Gaithersburg, MD 20899 (301) 975-4447
[email protected].
OMB Control No. 0693-XXXX
Expiration Date: XX-XX-XXXX
Fields marked with an * are required
First Name *

Last Name *

Title *

Employer's Principal Business *

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Work Email Address *

Work Address *

City *

State/Province *
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Alabama

Zip / Post Code *

Country *
United States

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Work Telephone *

Stakeholder Category *
Buildings

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Primary Standing Committee Interest *
Buildings and Facilities

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Secondary Standing Committee Interest
Buildings and Facilities

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Statement of interest relating to the committee *

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Relevant Experience *

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Key Interest Areas *

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Other Relevant Experience (not specific to chosen standing committee) *

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Education *

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Codes, Standards and Guidance Development *

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Professional Associations *

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SUBMIT

Community Resilience Panel Administrator
Address: 8537 Six Forks Road, Suite 600, Raleigh, NC 27615

©2016, Community Resilience Panel for

Telephone: 919.582.3400

Buildings and Infrastructure Systems. All

Email: [email protected]

Rights Reserved
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