GMAQ 2006 Application

Your application must be postmarked or faxed no later than August 1st. Mail or fax it to the address below. If you have any questions, call Harriet Browning at the GMAQ office, (901) 678-4268 or email to gbrowning@midsouth.rr.com


Greater Memphis Association for Quality
The University of Memphis
213 Alumni Center
Memphis, TN 38152-3760
Fax Number (901) 678-4301


Last Name First Middle Initial Title(Mr.Mrs.etc)
Employer Job Title
Work Address City Work Phone
State Zip Code Work Fax


Home Address City Home Phone
State Zip Code Home Fax

Mark an "X" in the box for preferred phone and mail:

Home Address Home Phone
Work Address Work Phone
Email Address

Employment Experience: (start with present, use additional sections if necessary)

Employer Dates: From To
Job Title: Fulltime Part-time(hrs. worked)
Organizational Unit Number of Employees Supervisor's Name
Type of products or services
Your duties (include type of products/services):
Experience with quality associated with above duties:
Areas of expertise (technical, professional, and quality):
Employer Dates: From To
Job Title: Fulltime Part-time(hrs. worked)
Organizational Unit Number of Employees Supervisor's Name
Type of products or services
Your duties (include type of products/services):
Experience with quality associated with above duties:
Areas of expertise (technical, professional, and quality):
Employer Dates: From To
Job Title: Fulltime Part-time(hrs. worked)
Organizational Unit Number of Employees Supervisor's Name
Type of products or services
Your duties (include type of products/services):
Experience with quality associated with above duties:
Areas of expertise (technical, professional, and quality):
Employer Dates: From To
Job Title: Fulltime Part-time(hrs. worked)
Organizational Unit Number of Employees Supervisor's Name
Type of products or services
Your duties (include type of products/services):
Experience with quality associated with above duties:
Areas of expertise (technical, professional, and quality):
Eduction and Training
Include name and location of institution(s) along with dates
and degree(s) received. Also include non-degree classes
that pertain to quality.
Achievements, recognition, and affiliations
Include professional affiliations relevant to quality along
with publications and major reports relevant to quality.
Why do you want to become an examiner?
Please state why you would like to become a
GMAQ Examiner.

Reference:

Please mail in a professional letter of reference to:
Greater Memphis Association for Quality
The University of Memphis
213 Alumni Center
Memphis, Tn 38152-3760

Reference Name Title
Employer Telephone Number