Board Member Information Form
Personal Information
Date Completed
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Month
-
Day
Year
Date
Name
*
Last Name
First Name
Formal Title / Honorific (e.g., Dr/Mr/Miss/Mrs/Mx)
*
Pronouns
Email for Board Correspondence
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Board Positions: Please check all that you are interested in at this time. We will have a vote a the first meeting.
*
Vice Chair
Secretary
Treasurer
Board Member at-Large
Bragging Links: Please insert links to your Linked In or any resources you want to share that highlight your work
*
Headshot (Upload Here)
*
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Upload Bio (or insert LinkedIn link to your bio above)
*
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Submit
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