Mitchell's Place Junior Board
Membership Application
Personal Information
Full Name
*
First Name
Last Name
Preferred pronouns
*
She/Her
He/Him
They/Them
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Birthdate
*
-
Month
-
Day
Year
Hometown
*
T-shirt Size
*
Please Select
Small
Medium
Large
Extra Large
2XL
Education
*
Name of School
City, State
Graduation Date
Major/Degree
School 1
School 2
School 3
Employment Information
Business Name
*
Job Title
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Information
Previous volunteer experience:
*
Why are you interested in joining Mitchell's Place Junior Board?
*
References
Please provide two
Name of reference 1
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Relationship
*
Name of reference 2
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Relationship
*
Additional Comments:
Who referred you to the Junior Board?
First Name
Last Name
Signature
By signing this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a member, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. By signing this application, I understand my duties as a Mitchell's Place Junior Board are including but not limited to: being a social media ambassador, attending junior board meetings, volunteering at events, securing sponsorships for events, recruitment of other members, and paying annual dues.
Date
*
-
Month
-
Day
Year
Signature
*
Clear
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability. Thank you for completing this application form and for your interest in joining Mitchell’s Place Junior Board.
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