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

Board Leaders wear many hats in fundraising! Which of the following impactful options/role do you MOST identify with?

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):

Committee Preference (Choose 1 or More):

Fundraising goals include funds you raise from others on behalf of The Milk Bank, but does not include your personal giving. Please describe how you plan to reach your fundraising goal – consider companies you may know interesting in sponsorships, personal network, employer matching, etc.

The Board is also active in increasing visibility, friendraising, collaboration building and outreach. How can you help promote The Milk Bank in your community and networks?

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);

I identify my gender as:

Age

Special Stakeholder Group

Optional space for questions or comments: