Board of Directors Application

Applicant Information

First & Last Name (with preferred titles) *

Personal Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Email *

Phone Number *

Date of Birth *

Company Information

Employer *

Job Title *

Business Size (Number of Employees) *

Employer Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Additional Information

Preferred method of contact *

Email Phone Either

Preferred location of contact *

Work Home Either

Please list any boards and committees that you serve on, or have served. Please provide the organization, your role/title, and dates of service. For example, "United Way, Treasurer, 2015-2018". *

Education, Training, or Certificates that could be relevant to your board service. *

How will Greater Grant County benefit from your involvement on the Board? *

Please describe any previous involvement with the Greater Grant County Chamber of Commerce. *

If 'Other' is selected above:

Committee Preference (We try to place you on your preferred committee, but also need to ensure good balance) *

Finance Governance Governmental Affairs Membership & Marketing No preference

Additional Comments