Emeritus Status Application / Nomination Form

 

Application and Nomination Form for CIRPA-ACPRI Emeritus Status

CIRPA-ACPRI members who were active in the Association and are retired are eligible for emeritus status.  This is both a recognition of the individual’s support of CIRPA-ACPRI and an opportunity for the individual to maintain connection with the Association.  Benefits include free annual membership, which provides access to discussion boards and communications, and a discounted conference registration rate.

Please complete the following information to apply for yourself or on behalf of someone you know is retiring.

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Name:*

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Institution/Organization:*

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Current Email:*

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Email to use after retirement (if nominating someone and you don't know the email, type unknown):*

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The date format is incorrect, please ensure the date format is YYYY-MM-DD

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Retirement date (approximate if unknown): *

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Activities that demonstrate an active member (check all that apply over lifetime of membership):*









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General statement of support for emeritus status (optional):*

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Areas of interest in CIRPA:*

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Would you be interested in volunteer opportunities with CIRPA?*

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Nominator (if applicable) Name:*

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Institution/Organization:*

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Email:*
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