First Name *

Last Name *

Title/Professional Role *

Institution/Organization *

Institution/Organization Location (Country) *

Enter required value United States Canada Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo Democratic Republic of Cook Islands Costa Rica Coted Ivoire Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island and Mc Donald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isleof Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Democratic Peoples Republic Korea Republic of Kuwait Kyrgyzstan Lao Peoples Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands British Virgin Islands US Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Sark

Email *

International ACAC Membership Type *

Enter required value Secondary (High School) Post-Secondary (College/University) Individual (IEC, Individual Associate, Small Organization) Community Based Organization (CBO) Non-Profit Organization For-Profit Organization Retired Professional

Region *

Enter required value Africa, Sub-Saharan Canada & U.S.A. Caribbean, Central America & Mexico East Asia Europe Middle East & North Africa South America South & Central Asia Southeast Asia & Oceania

Statement of Intent *

In 250-300 words (maximum), please share why you would like to be involved in the International ACAC Governance & Nominating Committee, and what you would contribute to this committee. Please also highlight what you have been involved in within International ACAC (if applicable).

Confidentiality and Conflict of Interest *

All members of the Governance & Nominating Committee will be required to sign the International ACAC Confidentiality Agreement and Conflict of Interest Statement. All discussions held as part of the GNC are to be kept confidential until official information is shared by the association. All GNC members are expected to make decisions in the best interest of International ACAC and remain neutral and objective when reviewing the slate of candidates for the Executive Board. While having a conflict of interest is not automatically disqualifying, it may require an individual to recuse themselves from certain discussions or votes. 

By checking this box, you confirm that you understand the importance of confidentiality and reporting any conflicts of interest honestly and completely should you be selected for the Governance & Nominating Committee.