Board Member Application

Board Member Application

To serve on the THBDF Board of Directors
The Tennessee Hemophilia & Bleeding Disorders Foundation is now accepting applications for Board Member positions. We appreciate your interest to serve. THBDF fills an important need in our state and community, and we believe that you will find serving on the Board a rich and rewarding experience.

As a director, you and your fellow board members are responsible for overseeing THBDF operations, while maintaining our commitment to THBDF's mission. This involves establishing our strategic direction, ensuring our compliance with all applicable legal requirements, and keeping THBDF financially healthy.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Employer Information
Employer Name
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you been employed there?
Affiliations
Education
Education (please include high school and college or technical school)
Additional Information
Have you ever been convicted of a misdemeanor or felony?

YesNo
If yes, please explain
Are you currently under investigation for a criminal action and/or on probation pending dismissal of a criminal action?

YesNo
If yes, please explain
Are you or anyone in your immediate family affiliated with any company, association or organization dealing with the treatment of bleeding disorders?

YesNo
If yes, please explain
Do you have any psychological or physiological impairment that would interfere with your performance as a board member

YesNo
If yes, please explain
How much time per month could you contribute toward performing your duties as a board member?
Please briefly explain why you would like to become a board member of the Tennessee Hemophilia & Bleeding Disorders Foundation. Be sure to include in your paragraph(s) what you believe you could contribute to the THBDF, and any ideas you may have for fundraising events and recruiting of new members:
Should be Empty:

Board Member Application

Employer Information

Education

Additional Information