Become a Panel Member

*First Name:
*Last Name:
Title:
*Company:
*Mailing Address (please include zip code):
Day/Preferred Phone No.:
*Email Address:
Are you a past panel member? Yes No
Would you be willing to serve, if needed, as an Assistant Panel Chair or Panel Chair? Yes No
Are you a United Way donor? Yes No
If you are not with a company or not with a company that runs a workplace campaign and would like to donate as an individual, click here.
If your company does not currently run a workplace campaign, but would like to learn more about starting one, contact Melanie Pohl at melanie.pohl@uwcnm.org.
Issue Area Preference: (For definitions, click here)
Education Health Income
Conflicts of Interest:
Agency Name:
Position Held:
Status/Term:
   
Agency Name:
Position Held:
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Agency Name:
Position Held:
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