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Board Membership Application
PO Box 2113, Winston-Salem, NC 27120
www.adamfoundation.org
First Name:
*
Middle Initial:
*
Last Name:
*
Residence
Address:
*
Phone:
*
E-mail:
*
Current Employer and/or Volunteer Position
Name:
Your title:
Address:
Phone:
E-mail:
Type of business or organization:
Brief Description of duties:
Preferred method of contact:
Work
Residence
Please list previous involvement in LGBT organizations:
Please include name of organization, role/title and dates of service.
Education/Training/Certificates:
Optional – Have you received any awards or honors that you’d like to mention?:
Please include a brief statement of interest in the Adam Foundation board position.:
*
Skills, experience and interests:
Finance, accounting
Personnel, human resources
Administration, management
Nonprofit experience
Community service
Policy development
Program evaluation
Public relations, communications
Education, instruction
Special events
Grant writing
Fundraising
Outreach, advocacy
Please check all that apply.
Other skills/experiences/interests not listed:
Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of the Adam Foundation.:
Please tell us anything else you’d like to share.:
