Fountain City Difference Project Inc. Board Member Application

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Please read through all of the Fountain City Difference Project Inc Board Nominations Kit prior to completing this form.

Note: By responding to the following, you are helping The fountain City Difference Project with its goal of building a diverse dynamic board that reflects the Tri-state area(Columbus, Phenix City, Harris County). Non-disclosure of demographic information is part of your right to privacy and will not impact your nomination.

Email *

Name (First and Last) *

Professional Affiliation/Title (Please list the title, company, business, and/or agency that FCDP can publish): *

Mailing Address (City, State, Zip): *

Preferred Email Address: *

Cell Phone: *

Social Media Handles/Website(s)/Links: *

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