Board Member Acknowledgment Form

Board Member Acknowledgment Form
Please complete this form to formally acknowledge your board membership, responsibilities, and contact information.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Board Position/Title
Start Date of Board Term
MonthDayYear
Date
End Date of Board Term
MonthDayYear
Date
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please acknowledge the following board responsibilities and policies:
Other (please specify)
Please provide any additional comments or information (optional)
Signature
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