Infant Massage USA Board of Directors Application Form

Board of Directors Applicant Form

Please complete the form below to apply to join our Board of Directors.
Personal Information
Date

MonthDayYear
Date
Name

Last NameFirst Name
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Home Phone
Demographic Information
Birthdate

MonthDayYear
Date
Pronouns
Languages
Business/Work Information
Title/Profession
Company/Organization
Email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Phone
Please list your current and past Board experiences
What are your current associations and/or club affiliations (include titles if possible)
Please list your skills and expertise
What is your educational background?
What do you feel is essential to ensure that the Board and staff are successful in attaining the goals for this organization?
What experiences, expertise, connections, or resources would you bring to Infant Massage USA?
Please detail your interest in joining this Board
What type of Board tasks do you prefer?
Directors of the Infant Massage USA Board might take on special projects, in addition to their Board responsibilities, to assist in Board led committees. Please check which you would be interested in joining.

Research and Education CommitteePartnership CommitteeBoard Development and Best Practice CommitteeSEED Selection CommitteeOther
Have you ever been engaged in any specific fundraising efforts? If so with whom, how, and what was the amount raised? Are you comfortable playing an active role in assisting Infant Massage USA with fundraising efforts?
How much time would you have to dedicate to Infant Massage USA (a week, a month, etc…)?
Please upload resume:*

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Please upload Certificate :*

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Please upload short bio:*

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Please note: Commitment to attend 4 out of the 6 board meetings held each year.

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 my signature, that the information contained within this application and all supporting documents is true, accurate, and complete to the best of my knowledge.

An electronic signature is accepted.

Signature________________________ ___________ __Date_____________

Infant Massage USA does not discriminate on any basis including race, sex, age, or religion.
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Board of Directors Applicant Form

Personal Information

Demographic Information

Business/Work Information