Indication of Interest in FINRA Service Form

First Name *

As you would like it to appear on official correspondence

Last Name *

Category *

Select the one that applies most closely to your situation

Category Other

If other, please specify:

Position

Firm/Company Name *

Title *

Primary Responsibility *

Address

Street Address *

Suite/Floor

City *

State *

Zip Code *

Email *

Phone *

Current Registration (if Associated with a Firm)

Firm CRD#

Individual CRD#

Number of Registered Reps. at Firm

Firm Size (if Associated with a Firm)

Areas Of Expertise Other

If other, please specify:

Interest in Service on the National Adjudicatory Council (NAC) *

Interest in Service on the FINRA Board of Governors *

Interest in Service on the FINRA Investor Education Foundation Board of Directors *

Current Committee Service *

Identify any FINRA committees (including any committees not listed above) on which you are currently serving. Also, indicate whether you are a current or former member of FINRA’s Board of Governors.

Candidate Biography *

Provide a brief biography or summary of your qualifications to serve on the committees for which you have indicated your interest. You may want to consider including your employment experience, areas of expertise, service on other industry-related boards and committees, etc. (No more than 500 words.)

Personal Statement *

Provide a statement of why you are interested in serving on a FINRA advisory committee, the NAC or the Board of Governors and how you hope to contribute. (No more than 500 words.)

Submitting this form does not guarantee a FINRA committee, Board, Foundation Board, or NAC seat appointment or outreach by FINRA staff.

*Required

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Indication of Interest in FINRA Service Form