Board of Directors Applicant Form
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Please complete all information below:
Name
*
First Name
Last Name
Age
*
Birthday
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
Date
Demographic Information
Place of Birth
*
Gender Identity
*
Male
Female
Other
Nationality
*
Business/Work Information
Title/Profession
*
Company Organization
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please list your current and past Board Experiences
*
What are your current associations and/or club affiliations? (include titles if possible)
*
Please list your expertise
*
Educational Background
*
Please detail your interest in joining this Board
*
What type of Board tasks do you prefer?
*
How much time would you have to dedicate to the organization? (a week, a month, a year, etc...)?
*
After your application has been reviewed you may be asked to interview in order for us to better get to know you. Please have a list of references available upon request. Thank you for your interest. I certify, by my signature, that the information contained within this application and all supporting documents (i.e., resume recommendation letter, et..) is true, accurate, and complete to the best of my knowledge. An electronic signature is accepted.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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