RWA Confidential Board Roster and RWR Information
(Only viewed by RWA staff and board members.)

First Name:
Last Name:
Address:

City:
State:
Zip Code:
Phone #:
Cell #:
Fax #:
E-mail Address for Confidential Roster:

RWR Roster Information
*The information collected below will be published in the Board roster in the RWR.*
Name:
Phone #:
Fax #:
Office hours:
E-mail:
Preferences
This information is requested to assist us in coordinating travel and planning Board events. The purpose is not intended to infringe upon anyone's privacy and will not be shared.
Travel
Preferred carrier 1:
Frequent flier # 1:
Preferred carrier 2:
Frequent flier #2:
Seat preference:
Hotel
Room preference:
Allergies:
Other request:
Other
ADA restrictions:
Dietary restrictions:
Morning Beverage preferences:
Afternoon Beverage preferences:
Emergency Contact
Name:
Phone #:
Cell #:

RWR Roster Information