Juneteenth of PBC Member Interest Form
Date
/
Month
/
Day
Year
Date
Full Name
*
Address
*
City/State/Zip Code
*
Phone
*
Email Address
*
example@example.com
What type of membership are you interested in?
*
Volunteer
Committee Leader
Committee Member
Other
List your passions and/or interests:
*
List your skills below
*
Please select the committee/s you may be interested in
*
Media/Marketing
Program Organizing
Community Relations
Steering/Organizing
Event Planning
Fundraising/Sponsorship
Related Experience
Additional Information
Please Upload Resume
*
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