Board Application

"*" indicates required fields

Your Name*

First Name Last Name

Business

Title

Address*

Street Address City State Zip

Phone*

Email*

Preferred Method of Contact*

Phone

In lieu of answering the next few questions, please feel free to attach a resume.

Resume

Accepted file types: pdf, docx, doc, odt, Max. file size: 8 MB.

Including your resume is optional - must be less than 8MB in file size

Occupational Background

Educational Background

West End Background

Please list any skills and/or educational background that qualify you to serve on the GINCC Board

List Relevant Organization, Scope, and Date(s) Served

Why do you want to be a member of the GINCC Board?*

Are you aware of any potential conflict of interest that may arise from you serving on the GINCC Board?*

Please list three (3) references who can attest to the information provided

Name of Reference 1*

Relationship of Reference 1*

Phone # for Reference 1*

Name of Reference 2*

Relationship of Reference 2*

Phone # for Reference 2*

Name of Reference 3*

Relationship of Reference 3*

Phone # for Reference 3*

I hereby certify that all the information in this application is true and complete. Permission granted to GINCC to verify any information provided and any attached documents for purpose of appointment to the Board. I release any person who provides information pertaining to me from all claims and liabilities that might otherwise result from such information or options.

Signature

Comments

This field is for validation purposes and should be left unchanged.