Contact Information

(First Name)           (Last Name)
(Street Address)     (City, State, Zip Code)
(Home Phone)        (Cell Phone)
(Email)

Employment Information

(Workplace)                (Street Address) 
(City, State, Zip Code) (Type of Industry) 
(Title)                         (Work Phone)
(Email)

(Description of work)

Volunteer/Employment experience with adoptees and/or adoption

List your volunteer/employment experience with adoptee and/or adoption organizations.

Board Service - Why do you want to serve on the AdopSource Board?

What is one thing you would like to see happen and how can it be accomplished?

Detail a great idea and list a few steps in how to achieve this.

Special Skills or Qualifications

i.e. language, traveling, education, connections

Interests - Which areas would you also be interested volunteering with?

Planning / Events Committee
Fundraising Committee
Financial Committee
Nominating Committee
Development / Research Committee

Agreement and Signature

(Re-Type Full Name)           (Today's Date)