JCYC Board Member Application

Board Member Application
Please complete the following form. All fields are required.
First Name:
Last Name:
Address:
City:
State/Province:
Zip:
Phone:
Email Address:
Occupation:
Company:
Why are you interested in serving on the JCYC Board?
What skills/area of expertise would you bring to the JCYC Board?
Please provide us with three (3) personal or professional references.
Reference #1 Name:
Phone:
Relationship:

Reference #2 Name:
Phone:
Relationship:

Reference #3 Name:
Phone:
Relationship: