Board and Committee Informational Application

Board and Committee Informational Application
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company
Position
What volunteer opportunity are you interested in (check all that apply):

Other
Briefly describe your passion for The Milk Bank’s mission. Please include any past board service you may have had.
Have you been referred by anyone currently engaged with The Milk Bank?
Please list:
What is your primary industry/expertise (check one):

Other
Committee Preference (Choose 1 or More):
Two primary responsibilities of board and committee leaders are to increase friend raising and fundraising. How would you activate your networks to increase visibility and resources for The Milk Bank?
Please list any relationship, current or former, that you have with for-profit milk banking, formula companies, and/or humanmilk substitutes.
The Milk Bank carefully guards against conflicts of interest in both business and personal matters. Please disclose any possible, perceived or actual conflicts of interest here. Examples may include but are not limited to endorsement of specific products, relationships with clients/vendors of TMB, entities whose primary purpose is to develop, market, or sell products/services in service to infant formula, human milk substitutes, or for-profit milk banking as well as efforts that are detrimental to infant health, breastfeeding or health equity.
Please disclose any conflicts of interest:
Upload: Please submit a résumé and bio if available

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Demographics (Optional)

The Milk Bank collects demographic data for reporting purposes and to combat disparities in healthcare. This information will not influence your application in any way.
I identify my race/ethnicity as (select all that apply);

Other
I identify my gender as:

Other
Age
Special Stakeholder Group
Optional space for questions or comments:
Should be Empty: