Full name: *

Please provide your name as it appears on your Driver's License

First Name

Last Name

Phone number: *

(###)

###

####

Address: *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which of your skills would be helpful to our Board? Check those that apply:

Community Networking

Strategic planning

Information technology

Program development

Photography/videography

Fundraising

Legal

Public Speaking

Financial management

Training/Camp Janus University

Marketing

Volunteer recruitment

Camper recruitment

If you are not selected as a member of the Board, or if you decide not to join, would you like to be a volunteer to assist our organization in various ways that match your skills and interests?

Yes

No

Perhaps