Board Member Application Home / Board Member Application Prospective Board Member Application Step 1 of 5 20% Name First Date Date Format: MM slash DD slash YYYY Home Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneHome Email Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work PhoneWork Email ProfessionMobile Phone Most Recent Volunteer HistoryOrganization NamePositionFrom - ToOrganization NamePositionFrom - ToOrganization NamePositionFrom - 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?YesNoWe 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
