Board of Directors Information

We’d like to get to know you!

Please take a moment to fill out this form for our records.

Full Legal Name:(Required)

Prefix First Middle Last

Preferred Name:(Required)

First Last

Home Address:(Required)

Street Address City ZIP / Postal Code

Business Address:(Required)

Street Address City ZIP / Postal Code

Where do you wish to receive your mail?(Required)

Home

Business

Home Phone:

Cell Phone:(Required)

Office Phone:

Email:(Required)

Occupation:(Required)

Where?(Required)

How long?(Required)

e.g. "11 Years"

Education - College/Degree(Required)

Education - Seminary/Degree(Required)

Church Membership(Required)

If your church/organization is not listed in the drop-down above please select "-Other" from the list.

Other Church(Required)

Church City Church Name

Church and Denominational Involvement:

Birth Date:(Required)

Hobbies and Interests:

Spouse's Name:

First Last

Occupation:

Children's Names:

Grandchildren's Names:

Any other information of interest: