Board Member Application | Park Co Sr Center

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First name

Last name

Address

Country/Region

Address

City

Zip / Postal code

Email

Primary Phone

Secondary Phone

Company name

Position

Why are you interested in applying for a position on our Board of Directors?

Please list any involvement you have had with PCSCC:

Please list your involvement with other Boards of Directors:

What are you committed to contributing to PCSCC?

Are you able and willing to serve at least one term of 3 years?

YES

NO

Are you willing to recruit new Board members?

YES

NO

Are you willing to fundraise on behalf of PCSCC?

YES

NO

Would you consider being an Officer on our Board of Directors?

Chairperson

Vice Chairperson

Secretary

Treasurer

Would you be willing to serve on a PCSCC Committee?

YES

NO

Signature

Sign in the box or use the keyboard to type.

Signature field is empty.

EIN# 81-0302200

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