Board of Directors Application
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
You must be at least 18 years of age.
*
Yes, I am at least 18 years of age
Driver's license state & expiration date
*
Drivers license number
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Format: (000) 000-0000.
How long have you lived in Oregon?
Are you certified in (select all that apply)
First Aid
CPR
Prior criminal offenses or convictions? Please list details including dates, probation, etc. Are there any pending criminal charges awaiting a hearing in a court of law?
*
Please briefly describe why you would like to volunteer to serve on the Board
*
Please briefly describe your academic and professional background, and other relevant experience (include any degrees or other professional titles you hold).
*
Please briefly outline the specific skills you bring, or contributions you hope to make, to the Board
*
Please list any other clubs, boards or professional organizations you are involved with (or have been involved with in the last 5 years) and specify your positions and years of service.
*
Please write a brief statement of your understanding of the organizations mission
*
Submit
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