Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Preferred Contact Method *

Phone

Email

Have you served on a nonprofit board before?

Yes

No

Which committee would you be interested in? *

Finance/Audit Committee (Grants Review, Monthly Financial Oversight, Banking & Investment Strategy, and Audit & 990 Review)

Governance Committee (Succession Planning, Bylaw Review, Nonprofit management best practices, and Board Recruitment)

Executive Committee (Transition Team, Strategic Planning, Legal Matters, and Time Sensitive Matters)

Resource Development Committee (Event Planning, Fundraising Strategy, and Outreach Strategy)

Program Committee (Measuring Outcomes, Oversight of Program Strategies, and Research similar organizations & new approaches)

Can you commit to the following? *

Attending bimonthly/quarterly board meetings Participating in at least one committee Making an annual meaningful financial contribution (or alternatively using your network to raise a financial contribution). Supporting or attending fundraising events.

Yes, I understand and agree to the expectations.

I would like to discuss this further.

I certify that the information provided is true and accurate to the best of my knowledge. I understand the responsibilities of a KCS Board Member.

Date

MM

DD

YYYY