Board Application

Application for Nomination to the Board of Directors

* Indicates required field

Name *

First

Last

Primary Phone Number *

Alternate Phone Number *

Email *

Address Line 1: *

Address Line 2 *

City: *

Province: *

Postal Code: *

Please tell us about yourself - your interests, your background, etc.: *

What experience and knowledge can you bring to the Board? *

Why are you interested in serving on the Board of NPDWC? *

Please provide three non-family references: list name, address, and phone number for each:

Reference 1:

Name *

First

Last

Phone Number *

Address: *

Reference 2:

Name *

First

Last

Phone Number *

Address: *

Reference 3:

Name *

First

Last

Phone Number *

Address: *

You must be willing to undergo Criminal Record and Child Abuse Registry checks. The Centre will pay for checks for those people approved for membership on the Board.

I agree to allow my name to stand as a candidate for the Board of Directors of the North Point Douglas Women's Centre for the two year term from the current date. I am willing to undergo Criminal Record and Child Abuse Registry checks.

This field is required. *

Agree

Submit Application

Board of Directors Application

Application for Nomination to the Board of Directors