Submit Board Member Request

If you have a board position you wish to post, please submit the following information. Items with a red asterisk are required.

Position Title: *

Position Information

Date to Post: *

Enter date in the following format mm/dd/yyyy.

Date to Remove:

Enter date in the following format mm/dd/yyyy.

Agency/Organization: *

Agency Description: *

50 words or less

Position Description: *

50 words or less

Expectations - to include meeting schedules and information on fundraising and committee work: *

50 words or less

Contact Information

Name: *

Address1:

Address2:

City:

State:

Zip/Postal Code:

Country:

Business Phone: *

With area code and country code

Business Fax:

With area code and country code

Email Address: *

Answer: *

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