Clone of SAMPLE for BrownCo-NonProfit Board Certificate Program Registration

NonProfit Board Service Program Registration

Saturday, June 7, 2014
9:30 A.M.-1:00 P.M.
Brown County Public Library
$15 PER PERSON
Contact Information
Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Preferred method of contact
Occupation
Title/Position
Board Service
What level of board service experience do you have?
Do you currently serve on a board of directors?
For which organization/s?
I am most interested in these topics (check all that apply)
Any other comments about what you would like to learn from this session.
A $15 registration fee is required of all attendees. Payment may be made before the session via mail or at the door on Saturday, June 7th. Cash or Check ONLY please.

Please make check out to: Brown County Humane Society, Inc.

Mail to: Brown County Humane Society, PO Box 746, Nashville, IN 47448

In Person: Brown County Public Library, Lower Level Meeting Room, 205 Locust Lane, Nashville, IN 47448
E-mail
I will submit my $15 registration fee:

Other
Thank you for your registration!
Should be Empty: