Affiliate Foundation Board Member Information Form

Contact Information

Name

First

Last

Recognition name

The name you would like to be called and would like used on our website and printed materials.

Title Title

If you selected other, please list your title:

Affiliate Community Foundation

Please select from the dropdown menu

Mailing Address

City

State/Province

Zip/Postal

Address type

Home

Business

Primary phone

Primary phone type

Spouse/partner name

Professional Information

If you are a professional advisor, please select the option below that best suits your role. If you are a professional advisor, please select the option below that best suits your role.

If you selected other, please list your role:

Do you work for a nonprofit organization that may apply for or receive funding from NCCF?

Yes

If yes, please name the organization:

Additional Information

Preferred pronouns Preferred pronouns

If you selected other, please list your preferred pronouns:

Race Race

If you selected other, please list your race: