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Name
Date of Birth
Occupation
Address
Phone
Cell
Email
Please briefly describe why you would like to join our Board of Directors
Organization
Role
What would you like to get for yourself out of your application on the Board? (e.g. What types of experiences, skills to develop, interests to cultivate, etc.)
Insurance/Risk ManagementStrategic PlanningHealth and SafetyProgram DevelopmentFinancial ManagementFundraising/Grants/ProposalsEvaluationCommunity NetworkingEducation/TrainingMarketingVolunteer ManagementPolicies and ProceduresOther
If you chose "Other", please specify.
Please feel free to offer any additional information or comments in support of your application.
I have read and agreed to the statement above.
