IMUSA Board Application

Board Application

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

PrefixFirst NameLast NameSuffix
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number*

Area CodePhone 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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