MFGD Board Member Application
GENERAL CONTACT INFORMATION
NAME (First and Last)
Your answer
DATE OF BIRTH
MM
/
DD
/
YYYY
PHYSICAL ADDRESS
Your answer
MAILING ADDRESS (If different from above):
Your answer
PRIMARY PHONE (Indicate home, mobile, etc.)
Your answer
EMAIL ADDRESS
Your answer
Preferred Method of Contact
EMERGENCY CONTACT PERSON (Name, Phone, and How They are Related)
Your answer
CURRENT OCCUPATION/COMPANY (If Applicable)
Your answer
Primary service(s) and area/population served in your current occupation (If Applicable)
Your answer
Hours per month you could devote:
Your answer
Can you attend monthly Tuesday evening Board Meetings, 6:30-8:30pm?
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