Board of Directors Application Form

Board of Directors Application

It would be very helpful, if you could provide the nominating committee with as much information as possible for the selection process. All information will be kept confidential.

Thank you.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Place of Employment

How do you know the director nominating you?

How did you hear about The Blood & Tissue Center Foundation?

Are you currently serving on another board or served in the past? Please list if applicable:

What networks, professional groups, cohorts can you introduce to the organization? Please explain.

What specific skills or contributions can you share? (legal, accounting, marketing etc), Please explain.

Are you willing to serve a 3 year term, with an opportunity to serve additional yearly terms?

Yes

Please provide any other information you would like us to know about you.

Signature(Required)