Board Member Covenant Agreement
Please review and complete this agreement to acknowledge your commitment and responsibilities as a board member.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Board Position/Role
*
Please Select
Chairperson
Vice Chair
Secretary
Treasurer
Member at Large
Other
Start Date of Board Term
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
End Date of Board Term
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously served on this board?
*
Yes
No
Please list any other boards or organizations you are currently affiliated with.
Confidentiality and Conflict of Interest Declaration: Do you agree to maintain confidentiality and disclose any potential conflicts of interest during your term?
*
I agree
I do not agree
Signature (Please sign to acknowledge your agreement and commitment)
*
Submit Agreement
Submit Agreement
Should be Empty: