Board Member

or

Application Form

TO: Chairman, Nominating Committee

Name: ____________________________________________________

Address (Home): ____________________________________________

Address (Business): __________________________________________

Telephone (Home) _________________ (Business): ________________

Email (Home): _______________________________________________

Email (Business): _____________________________________________

Occupation: _________________________________________________

Education: __________________________________________________

___________________________________________________________

What skills or qualities do you think qualify you to sit on The Lions Hiram Young

Community Service Center’s Board?

______________________________________________________________________

Please highlight your volunteer experience:

______________________________________________________________________

Please tell us of volunteer efforts or contributions made by you for your community:

______________________________________________________________________

Please tell us what you feel you can bring to the board:

______________________________________________________________________

Other Comments:

______________________________________________________________________

Signed: _________________________________________

Date: ___________________________________________