Board Of Directors Application Form

Employment/School

PLEASE INDICATE THE COMMITEE AND BOARD TO WHICH YOU HAVE SERVED ON IN THE PAST? OR, CURRENTLY? (And please indicate number of years served on the respective committee.)

PLEASE INDICATE THE BOARD WHICH YOU ARE INTERESTED IN APPLYING FOR BY DESIGNATING THEN IN ORDER OF PREFERENCE (3 stars for highest preference, 1 star for lowest preference)

Grocery Board
HIAH Board of Directors
Mere Board of Directors
PLEASE CHECK ALL THAT APPLY:

EXPERIENCE

SKILLS, TRAINING & EDUCATION