IMUSA Board Application

Board Application

Please complete the form below to apply to join our Board of Directors.
Full Name *

Prefix First Name Last Name Suffix
Current Address *

Street Address

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City State / Province

Postal / Zip Code Country
Email Address *
Phone Number *

Area Code Phone Number
Employer Name *
Employer Address *
Licensure / Education *
Upload Resume *

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Please attach a short essay explaining your interest in serving on the Infant Massage USA® Board of Directors and why you feel you are a good candidate for this role. *

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Short Bio *

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