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Board Nomination

I support the mission and philosophy of LIFE Center for Independent Living, and want to become more involved in helping the Center achieve its goals. Please consider me, or the person I am suggesting below, for nomination to the LIFE Center for Independent Living Board of Directors. I understand that individuals with current memberships are eligible for nomination to the Board. To submit the board nomination form, please fill out and submit the form below, or print and mail in the printable version of the Board Nomination form. For more information on becoming a Board member, please contact Gail.

Date:
Name:
Address:
City:
State:
Zip:
Telephone:
Please Check One	Voice TTY FAX
E-mail:
Employer:
Work Phone:
You may call me at work:	Yes No
	I understand that Centers for Independent Living are required by law to have a majority of Board members with disabilities and to have cross-disability representation on the Board. I therefore disclose, and ask that you keep my response private:
I have a disability:	Yes No
My Disability is:
Preferred format for print materials:	Regular Print Large Print Braille CD Audiotape E-mail
Preferred method of receiving mailings	Mail E-mail
I am interested in serving on LIFE Center’s Board because:
I would bring the following personal experience, community contacts, or skills to the Board: