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Board Member Application Name ___________________________________ Date ______________________ Address_________________________________________________________________________ Telephone (Home) _______________________ (Work) __________________________E-Mail Address ________________________________________ Occupation ____________________________________________The CILNM Board of Directors meets approximately six times per year on alternate months on the third Thursday at 2:00 p.m. In addition there may be committee and/or community work which you will be involved in which will pose a larger time commitment. Can you make this commitment to CILNM? _________________________________ Briefly describe why you wish to serve on the CILNM Board of Directors: Briefly describe your experience with disability:
Please Print, Complete and Mail To: CILNM
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