Volunteer Form

Please complete this form to have your name added to our volunteer database. You may type your information directly onto this form and submit it electronically. Or, print and complete the form and return it to the address below. Call 202-223-8196 if you have any questions.

Date:	(mm/dd/yy)
First Name:
Last Name:
Suffix:
Title:
Organization:
Street Address:
City:
State:
Zip Code:
Country:
Phone:
Fax:
Primary E-mail:
Secondary E-mail:
*Tell Us About Yourself!* 1. What's your area(s) of expertise or practice? 2. Are you currently an Academy volunteer? Yes No If yes, please list the nature of your volunteer work. 3. Why do you want to be an Academy volunteer? 4. How much time per month could you devote to Academy volunteer work? 5. For what other professional organizations have you been a volunteer? (optional) 6. What was the nature of your volunteer work for other professional organizations? (optional) 7. Some volunteer activities require traveling. Are you willing and able to travel? 8. Are you interested in participating on a particular committee or project? Yes No If yes, explain. 9. List any experience or skills you have that relate to your volunteer interest. 10. Are you an Associate? Yes No Are you a Fellow? Yes No 11. List your designation(s) and the accrediting organizations. *Statistical Purposes ONLY* 1. If an Academy member, how long have you been a member? 2. Gender: Male Female 3. Age Range: 25-35 36-45 46-55 56-65 over 65 4. Comments. Please do not mail or fax this form if you submit it electronically. To print, go to your browser menu bar and choose "File", then "Print". You may fax the printed form to the Membership Department at 202-872-1948. Or mail to: American Academy of Actuaries Membership Department 1100 Seventeenth Street NW, Seventh Floor Washington, DC 20036