Committee/Task Force Sign-up Form
If you are interested in volunteering for a PATH Intl. committee/task force please fill out this form completely. PATH
Intl. will share your information with appropriate committees and identify opportunities for you to put your skills to use
on PATH International’s behalf. Thank you so much for taking the time to help make a difference!
NAME: PATH Intl. Member #:
Address:
City/State/Zip/Country:
Day Phone: Evening Phone:
Email Address:
Are you 18 years of age?
YES NO
What committee, region or organizations are you interested in volunteering for?
Program and Standards Oversight Committee
Membership Outreach Committee, Region____
Accreditation Subcommittee
Health & Education Advisory
Certification Oversight Committee
Standards Review Task Force
Riding Certification Subcommittee
Quality Assurance Task Force
Therapeutic Driving Certification Committee
International Conference Host Task Force
Interactive Vaulting Certification Subcommittee
Equine Welfare Committee
Regional Conference Task Force
State Chair of____________
Equine Specialist in Mental Health and Learning
Subcommittee
Equine Services for Heroes Committee
Other_______________________________
Please circle the following skills you would like to share or interests you have:
Accounting
Community Leadership
Management
Training/Mentoring
Development
Education/Curriculum
Publishing
Marketing
Bilingual
Riding
Driving
Vaulting
Evaluator
Site Visitor
Mental Health/Special Credentials: PT OT SLP Psychologist Doctor
Mental Health Experience/Interest
Other:_____________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you been convicted of a felony within the last five years?
Yes No
If yes, please describe, on a separate sheet, the circumstances of your conviction, including the date, nature, and
place of the offense and disposition of the case. A felony conviction will not necessarily bar you from
employment since this will be looked upon as only one of the factors considered in the employment decision
and is evaluated in terms of the nature, severity and date of the offense.
Please attach a cover letter and resume to this form.