Board Engagement Application

To apply, please complete the application below. Applications are due by April 15, 2019. Applicants will be notified in early May regarding their selection status. If any questions please email us at emergebroward@gmail.com
The cost to participate in the Board Engagement program is $50, due upon selection.

Board Engagement Application

* Indicates required field

Name *

First

Last

Birthday *

PERSONAL CONTACT INFORMATION

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Email *

Cell Phone Number *

EMPLOYMENT INFORMATION

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Place of Business *

Position/Title *

Business Phone Number *

MEMBERSHIP INFORMATION

Dates of Emerge Broward membership *

Involvement as an EB member *

APPLICATION QUESTIONS

Please provide an overview of what you believe to be your most significant volunteer and leadership roles (with and/or outside of Emerge Broward): *

What social/community issues are of importance to you and why? *

Please provide an overview of what you believe to be your most significant volunteer and leadership roles (with and/or outside of Emerge Broward): *

PROFESSIONAL REFERENCE

Name *

First

Last

Email Address *

Company / Title *

Phone Number *

AGREEMENT

I understand the expectations of participation in the Board Engagement program, and I am willing to fulfill all responsibilities as described. I confirm that I am a paid Emerge Broward member.

Please Confirm *

I AGREE

Signature *

First

Last

Submit

Board Engagement

Board Engagement Application

EMERGE BROWARD