Member Advisory Committee Application

First Name

Last Name

Address

City

District

Home Phone

Cell Phone

Email address

How long have you been an NCE member?

Have you ever been a member of an electric cooperative before NCE?

Yes

Where? (Name of co-op or city)

When/how long?

Current Employer

Employer Location

Title

Years of Service

Community Involvement

Please list your top three community organizations you are currently involved with, or have been involved with in the past.

Re-order	Name	Dates Participated	Duties/Responsibilities	Weight	Operations
	Name	Dates Participated	Duties/Responsibilities	Item weight

more items

What does being a member of a cooperative mean to you?

Why do you want to be on the Member Advisory Committee?

If selected, what are three things you hope to learn about NCE?

Applicant's Signature

Sign above

Date