MdH Board Membership Application

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* 1. First and Last Name

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* 2. Current Address (include City, State, and Zip Code)

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* 3. Primary Email Address

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* 4. Cell Phone Number

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* 5. Birth Month and Day

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* 6. Mujeres de HACE Class Name and Year

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* 7. Current Employer

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* 8. Position Title

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* 9. What position are you interested in leading?

 Board Chair

 Vice-Chair

 Secretary

 Treasurer

 Marketing Committee Chair

 Program and Event Committee Chair

 Professional Development Committee Chair

 General Advisory Board Member

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* 10. Why are you interested in the specific role indicated above and how would you be able to contribute to the role? Maximum of 500 words.

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* 11. List any current leadership roles you have and dates. (Extracurricular, Community Service, Honors/Achievements, Past & Current Employment)

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* 12. By clicking Yes below AND typing my full name, I certify that all the information included in this application package has been provided to the best of my ability.

Yes

No

Type Full Name