Governance Panel Request

Submit the form below to express interest in an appointment to the Governance Panel. All fields are required. The Board will review the submitted information at the time of submission or at a later time when new Governance Panel appointments are being considered.

Each Governance Panel appointee shall:

  • Have been an active X12 member representative for at least one year
  • Be well-versed in X12 policies and procedures
  • Have a solid understanding of Robert's Rules of Order
  • Have strong written communication skills
  • Be willing to participate regularly and actively for a two-year term of appointment

Member Name:
Member Representative Name:
Member Representative Email:
Qualification Statement:

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