Committee Member Application

First Name *

Last Name *

Company/Affiliation

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Please check any or all committees you are interested in serving on *

Have you served on a Kishwaukee United Way committee or Board of Directors before? *

Yes

No

Why are you interested in serving on this committee? *

What contribution(s) do you believe you could make to the committee? Feel free to list any special skills. *

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