Member Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Email*

Current Position*

Current/ most recent employer*

Relevant Experience and/ or Employment:*

Please check all areas of expertise/ contribution you feel you can make to further our mission:*

Please list current Board Committees you are serving on.

What other volunteer commitments do you currently have?

Why are you interested in continuing to serve as a Board member?*

Please share any other information you feel important for consideration for your application as a Board candidate.

CrossWinds Board Member Renewal

If you have been serving on CrossWinds Board and are wanting to continue serving, please go ahead and submit a renewal application.