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NHS Board Member Profile
Personal Information
Name:
*
Birth date:
Home address:
*
Subdivision:
City:
*
Zip code:
*
County:
*
Home phone:
*
Naperville Heritage Society Board Involvement
Current board position:
*
Past positions held:
Length of NHS affiliation:
*
Business Information
Business name:
*
Address:
*
Phone:
*
Fax:
Business title / occupation:
*
Length of business affiliation:
*
Other business affiliations or ownership (include business names, positions and length of affiliations):
Family
Spouse's name:
Maiden name (if applicable):
Spouse's place of work:
Position:
Business address:
Business phone:
Spouse's community involvement:
Children (include names, years of birth and schools):
Education
College / university attended (give name, location, degree and year):
Community Involvement
Boards / corporations, foundations and not-for-profit organizations on which you serve or have served (include names and dates):
Organizations to which you belong (include names, locations and positions):
Awards / publications:
Naperville Heritage Society / Settlement activities in which you have been or are currently involved:
Where would you prefer to receive NHS correspondence?
*
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