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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