LeadUS Mentoring Program 2015-16

Board of Directors Application Form
Candidate Information
Name

Last NameFirst Name
Business/Work Information
Company Organization
Title/Profession
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email
example@example.com
Will you be able to make this commitment to the Stratford & District Chamber of Commerce?

YesNoMaybe
Please list your current and past Board experiences
What are your current associations and/or club affiliations? (include titles if possible)
Why do you want to serve on the Stratford & District Chamber of Commerce?
What talents do you feel you could contribute to the success of the Chamber?
What is your educational background? Please list any accreditations
What do you believe are the two most significant issues facing Businesses in Stratford & District?
I am excited about working on

Chamber of Young Professional EventsAdvocacy IssuesMarketing Chamber Member BusinessesEvents (Business Excellence Awards, Golf Tournament ect.)Professional DevelopmentCommunity Development
Feel free to include a copy of your resume, only if you have one.

Cancelof
After your application has been reviewed you may be asked to interview in order for us to better get to know you. Please have a list of references available upon request.

Thank you for your interest.

I certify, by clicking the Apply button, that the information contained within this application and all supporting documents (i.e., resume, recommendation letters, etc.) is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.
Should be Empty:

Board of Directors Application Form

Candidate Information

Business/Work Information