2018 Brent's Place Leadership Council Application
Thank you for your interest in joining the Brent's Place Leadership Council! Please complete the short form below and someone will be in touch within one week of completion. If you have any questions, please contact the Brent's Place Staff, Annie at athompson@brentsplace.org.
Email address *
Name *
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Address *
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Phone Number *
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Email *
Your answer
Company & Title *
Your answer
Date of Birth *
Your answer
Why do you want to be a member of the Brent's Place Leadership Council? *
Your answer
As a member, what do you think you could bring to our group (Special Skills or Expertise)? *
Your answer
How do you like to be recognized for your contributions? *
Your answer
What are some of your expectations of Brent's Place and the Executive Committee of Brent's Place Leadership Council? *
Your answer
How much time on a monthly basis do you want to contribute to the group? *
Your answer
Which of the following professional development events are you interested in? (select all that apply) *
Required
BPLC Membership donation dues are $120, or $10/month. How would you like to pay? *
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