Board Member Application

* Indicates required field

Title: *

Name: *

First

Last

Email: *

Phone Number: *

Address: *

Line 1

Line 2

City

State

Zip Code

Country

Ethnicity: *

Gender: *

Age: *

Date of Birth: *

Company Name and Address: *

Position *

If you have answered other from the previous question, please specify. *

How much time per month are you willing and able to give to help CMSMC board? *

2 Hours 5 Hours 10 Hours Other

If you have answered other from the previous question, please specify. *

Have you ever been a member of a nonprofit Board of Directors? (If "yes" please specify) *

Are you currently serving on other boards? *

If yes, on what boards are you serving? *

Fundraising is critical to the work of the Board each year because this is a non-profit organization that receives a grant based on the Center’s ability to fundraise a certain amount. Describe your willingness and ability to help fundraise: *

Why are you interested in joining the Board of Directors of CMSMC? *

Is there any additional information you would like to share with us? *

I HAVE READ AND UNDERSTAND THE "GENERAL RESPONSIBILITIES OF THE BOARD" AND FEEL I AM FULLY PREPARED TO MAKE THE NECESSARY COMMITMENTS FOR A TWO-YEAR TERM.

Signature: *

Date: *

Thank you for your interest.