Steering Committee Member Agreement Form

1
Email* This field is required.Please provide a reliable email address you can be contacted through.
example@example.com
2
Name * This field is required.
She
She
He
Them
Pronouns
First Name
Last Name
3
Are you Volunteering or a Committee Member?* This field is required.
Please Select
Please Select
Committe Member
Volunteer
BOTH
4
Contact Number* This field is required.Phone number where you can be called/texted
Area Code
Phone Number
5
Emergency Contact Name & Phone Number?* This field is required.
6
Shirt size - unisex shirts with a regular crew neck* This field is required.* (if you plan on volunteering up until the date of the KBMH week events please select a shirt size, otherwise select ‘not applicable’). Dates: April 11-17th 2026.
XS
SM
M
L
XL
2X
I don't plan on Volunteering during KBMH week
7
Do you have any health or physical limitations that will not allow you to stand or sit for as long as an hour, lift/push/pull/carry as much as 40 pounds? If so, please tell us more below so we can accommodate your needs. If not, please move on to the next question.
8
Have you downloaded the telegram app that we will be using for planning and days of conference, including group/direct messaging to be a committee member?* This field is required.
Yes- Telegram is locked and loaded!
No- but I'm going to do it right now! Thanks for the reminder.
9
# of hours/days you can dedicate to the steering Committee?* This field is required.Please list your hours and days you can dedicate your time in being a part of the steering committee or KBMHC.
10
Steering Commitee Member agrees to the following MOU terms and conditions:

Commitee Member agrees to be present and punctual (on time) for all assigned shifts while at KBMH week performing services voluntarily for KBMHC or be subject to reimbursement to KBMH via Community Shares of Tennessee for applicable travel registration, swag and accommodation expenses.

Commitee Member agrees that she/he/they are volunteering solely for personal, civil, charitable or humanitarian purposes without promise or expectation of compensation, benefits or future employment from KBMHC.

Commitee Member will perform tasks under the direction of KBMH Staff during the 2026 week and all related events, which include planning and tabling at community events to increase community engagement for KBMH confrence.

Commitee Member will assist with assignments and duties such as event planning, ushering event patrons and attendees leading up until the conference, and distributing KBMHC marketing materials or retrieving items for KBMHC staff, as well as providing directions to navigate an event space. Some set-up and breakdown duties may be required.

Commitee Member acknowledges that she/he/they are not an employee of KBMHC, and is not entitled to receive salary, benefits or other compensation beyond that agreed upon such as flight and hotel accommodations. Member further acknowledges 100% of all funds raised by him/her/them while volunteering for KBMHC will go to KBMHC as a nonprofit organization.

Commitee Member understands that she/he/they does not qualify for worker’s compensation benefits and are expected to carry personal medical insurance to cover medical expenses for any injury she/he/they may incur while performing services voluntarily for KBMHC.

The parties agree that this is the entire Agreement between them and that no other Agreement, either oral or written, exists outside of this Agreement regarding the Commitee Member roles, tasks and responsiblities described above.

Commitee Member hereby grants full permission to KBMHC to use their name and likeness in all forms in any and all media including but not limited to publications, brochures, books, magazines, photo exhibits, video, and/or other media or commercial, informational, educational, advertising, or promotional materials without compensation.

Commitee Member agrees that they will not use the name and likeness (photo, video, voice recording and/or any and all forms) of any client or patron of KBMHC (moms, kids, babies, influencers, performers) in any and all forms of media, including but not limited to social media unless they have written or verbal consent from client/patron.

Commitee Member releases KBMHC, its affiliates, members, predecessors, successors, assigns, agents, independent contractors, directors, officers, representatives, attorneys, insurers, and all persons acting by, through, under or in concert with any of them (collectively “Releasees”) from any responsibility or liability for injuries to member, including without limitation, personal injury, death, and/or damage to or loss of property, arising out of the known and unknown risks associated with these member duties, the non-profit’s negligence, and/or accidental occurrences while visiting or otherwise engaging in activities before, during, or after KBMHC 2026 events.
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As a Steering Committee member, you will:

• Contribute to shaping the theme and agenda for Black Maternal Health Week events.
• Help identify and engage dynamic speakers, panelists, and workshop facilitators.
• Offer insights to ensure all programming is culturally responsive and impactful.
• Collaborate on outreach, marketing, and community engagement efforts.
• Support event planning, logistics, and fundraising initiatives.

Please note: In 2026, we will not be hosting a single conference. Instead, we will curate a weeklong series of events in celebration of Black Maternal Health Week, April 11–17, 2026.

Commitment
• Monthly virtual meetings (more frequent closer to KBMH events).
• Active participation in planning discussions and tasks.
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Date of Service* This field is required.Filling out the form will begin your steering committee member service.
Date
Year
Month
Day
13
Signature* This field is required.In witness thereof, party named below enters this agreement as of date in next section. Please enter Volunteer Name (and Parent or guardian's name if volunteer is under 18 years old):
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