HSI Advisory Council Application

Qualified Individuals are invited to apply to serve as a member of the Advisory Council by completing this application form.
Name:
Title:
Company Name:
Email Address:
Work Phone:
Cell Phone:
Address:
City:
State/Province:
Zip/Postal Code:

Describe Current Position and Responsibilities:
Please describe your work or experience with hose assemblies or hose applications:
With which industries and products do you work most frequently?
What would you hope to accomplish as a Hose Safety Institute Council Member?

Do you have the authority to commit the time required for this role?
Supervisors Name:
Supervisors Title:
Supervisors Email:
Referred By:

I have read and understand the requirements for, and responsibilities of, membership on the Hose Safety Institute Advisory Council and agree to comply with them if selected to serve.
   - denotes required fields

Join the NAHAD Community

Become a part of the community dedicated to growth and prosperity in the hose and hose accessory industry.