IAC Membership Application Page – Energy Insurance Mutual Limited

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Energy Insurance Mutual Limited
Insurance Advisory Committee (IAC) Membership Application

Personal Information

Name

First

Last

Position/Title:

EIM Member Company

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email

Phone

Please summarize your experience, qualifications, special skills, and/or education that you feel will enhance the IAC

Why do you want to serve on the IAC?

If you currently serve, or have previously served, on other committees, please list the name of the organization, the nature of your role, and the length of time you served.

Please indicate any special interest and/or experience in any of the following current IAC Task Forces: Cyber Risk, Emerging Risk, Energy Market Evolution, ESG, and Regulatory Risk.

EIM endeavors to maintain a diverse Insurance Advisory Committee (“IAC”) that reflects the composition of the overall EIM membership. As such, EIM considers several factors in the pursuit of ensuring a diverse IAC membership. Please provide the following information about your organization:

Operational geography

Energy/utility operations

If Other, please specify

Organization type

And more about yourself:

Education level

Areas and years of experience

Enter values for all that apply.

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Risk Management

Years

Underwriting

Years

Insurance

Years

Finance

Years

Claims

Years

Human resources

Years

Other

Years

Other Description

Description

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EEO/Diversity Information

Gender

Optional

Race/Ethnicity

Optional

Upload Resume

Click or drag files to this area to upload. You can upload up to 2 files.

Submission Date