First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone

(###)

###

####

Type of Business/Organization and Your title

Primary service(s) & area/population served

Preferred method of contact ie: phone or email

Please list boards and committees you serve on or have served on

(business, civic, community, fraternal, political, professional, recreational, religious, or social)

Education/Training/Certificates

Have you received any awards or honors you'd like to mention?

How do you feel QHVA would benefit from your involvement on the board?

Skills, experience and interests

Finance, accounting Education, instruction Personnel, human resources

Special events

Administration, management Grant writing

Nonprofit experience Fundraising

Community service/outreach, policy development

Public relations

Please list any groups, organizations or businesses which you could serve as a liaison on behalf of QHVA

Expectations

Can you meet on the third Thursday of the month at noon? /Can you commit to monthly meetings?

Expectations continued

Board positions run for a 3 years and can run 2 terms consecutively. Can you commit to serving one or two terms?

“FOR THE LOVE OF QUAIL HOLLOW”

Working In cooperation with…