Shehaqua Representative Sign-up Form

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Please fill out the following form to be added to our list of Shehaqua Representatives. (The information provided will be accessible to the Shehaqua Council only.)

Expectations and Benefits of Being a Shehaqua Representative:

● Be willing to serve the Shehaqua Family

● Participate in the vote for Shehaqua Council candidates in the yearly Council election

● Be willing to have your contact information shared with members of the Shehaqua Council

● Respond to email correspondences regarding the Shehaqua community and programming (correspondence will be occasional, but important)

● Notify the Council when you are no longer willing or able to serve

First Name *

Last Name *

Email *

On average, how often do you check your email? *

Several times a day

Once a day

Two or three times a week

Once a week

Less than once a week

Cell Phone *

xxx-xxx-xxxx

Home Phone *

xxx-xxx-xxxx

Address Line 1 *

Address Line 2

City *

State / Province *

Zip Code *

Number of years you attended Shehaqua Family programs *

Which Shehaqua Family program/s did you attend? *

Family Camp (in summer)

Harvest Festival

Winter Retreat

Spring Gathering

Vision Quest

Required

I hereby apply to become a Shehaqua Representative. I am aware of the responsibilities that come with this position and I will do my best to fulfill them.

Required

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