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Profile

2. NHS Board Member Profile
4. Personal Information
6. Name:*
7. Birth date:
9. Home address:*
10. Subdivision:
12. City:*
13. Zip code:*
15. County:*
16. Home phone:*
18. Naperville Heritage Society Board Involvement
20. Current board position:*
21. Past positions held:
23. Length of NHS affiliation:*
25. Business Information
27. Business name:*
28. Address:*
30. Phone:*
31. Fax:
33. Business title / occupation:*
34. Length of business affiliation:*
36. Other business affiliations or ownership (include business names, positions and length of affiliations):
38. Family
40. Spouse's name:
41. Maiden name (if applicable):
43. Spouse's place of work:
44. Position:
46. Business address:
47. Business phone:
49. Spouse's community involvement:
51. Children (include names, years of birth and schools):
53. Education
55. College / university attended (give name, location, degree and year):
57. Community Involvement
59. Boards / corporations, foundations and not-for-profit organizations on which you serve or have served (include names and dates):
61. Organizations to which you belong (include names, locations and positions):
63. Awards / publications:
65. Naperville Heritage Society / Settlement activities in which you have been or are currently involved:
67. Where would you prefer to receive NHS correspondence?*

    1. Home
    2. Office
69. Other comments:
Leave This Blank:


71. 1. Receive an email copy of this form.
72. Email address

    This field is not part of the form submission.

73. Submit

* indicates a required field