Board Member Waiver Form
Please complete this form to acknowledge and accept the waiver terms for participation as a board member.
Full Name
*
First Name
Last Name
Board/Organization Name
*
Role or Position on the Board
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Meeting/Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Waiver Acknowledgment
Signature
*
Signature Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: