Board Member Application Home / Board Member Application Prospective Board Member Application Step 1 of 5 20% Name First Date MM slash DD slash YYYY Home Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneHome Email Business Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneWork Email Profession Mobile Phone Most Recent Volunteer HistoryOrganization Name Position From - To Organization Name Position From - To Organization Name Position From - To References Please list two people who know you well and would be willing to provide reference information.Name First PhoneName First Phone How did you learn about the Alzheimer's Disease Association of Kern County, Inc.?Do you have experience with the frail elderly? If so, how?Board meetings are held on the third (3rd) Tuesday of each month from 6:00 - 7:30 PM during which committee reports and voting take place. Would you consistently be able to attend at this time? Yes No We also ask each board member to serve on at lease one committee (an additional 1-2 hours per month. Most committees meet during business hours. Which of the following areas interest you? (Check all which apply) Marketing Fundraising Speakers Bureau Facilities Finance Personnel Other (please describe in comments) We also ask that whenever possible you support the organization by attending fundraising events, open houses, volunteer recognition occasions, etc.Comments
