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
1101 East 37th Street (Mesabi Mall) Suite 25
Hibbing MN  55746