Stafford County CHUMS Membership Application

Stafford County CHUMS Membership Application

Complete this form to join Stafford County CHUMS, Inc. and contribute to community initiatives.
First Name
Middle Name
Last Name
Preferred Title
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Contact
Personal Information
Age Range
Marital Status
Do You Have Children?
Number of Children
Educational Background
High School Name
High School Completion Type
College/University Name
Degree Earned
Major
Graduate School Name
Graduate Degree Earned
Field of Study
Additional Certifications, Licenses, or Credentials
Additional Education Details
Professional Information
Industry
Employer
Position Title
Occupation/Profession
Professional Certifications
Years of Professional Experience
Community Involvement
Are you currently a member of any organizations?
If yes, please list the organizations
Volunteer Experience
Community Service Interests

Other
CHUMS Interest Information
Why are you interested in joining Stafford County CHUMS, Inc.?
What strengths and talents would you bring to Stafford County CHUMS, Inc.?
Describe any special skills, experiences, or professional expertise that may benefit the organization.
How did you hear about Stafford County CHUMS, Inc.?

Other
If referred by a member, what is her name?
Photo & Document Upload
Professional Headshot

Cancelof
Resume

Cancelof
Additional Supporting Documents

Cancelof
Acknowledgement
Applicant Statement
I Agree
Electronic Signature
Date

MonthDayYear
Date
Stafford County CHUMS Use Only
Date Application Received

MonthDayYear
Date
Membership Committee Review Date

MonthDayYear
Date
Interview Scheduled
Interview Completed

MonthDayYear
Date
Approved
Not Approved
Notes
Add Your Photo Upload

Cancelof
Should be Empty:

Stafford County CHUMS Membership Application

Personal Information

Educational Background

Professional Information

Community Involvement

CHUMS Interest Information

Photo & Document Upload

Acknowledgement

Stafford County CHUMS Use Only