Associate Board Application

Name

First Last

Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone

Work Phone

Company

Position

Does your company support your involvement with Little City’s Associate board?

Yes

I haven’t asked, but I plan to

Do you serve on any other philanthropic boards/ committees?

Yes

How did you hear about Little City?

Please tell us why you would like to be part of the Little City Associate Board:

Which of the following areas are you most interested in participating?

Fundraising

Engagement

Events

Please share how you can make the greatest contribution to Little City through your interests above:

By e-signing below, I certify all information is true and correct to the best of my knowledge.

Date