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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:


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

    This field is not part of the form submission.

72. Submit

* indicates a required field