Board of Directors/Executive Application Form

Thank you for your interest in joining the Caribbean College of Family Physicians- Jamaica Chapter (Not-for-profit) Board/Executive! Use this form to provide useful information about yourself, to ensure the best match between you and the College that you may be considered for its Board of Directors/Executive.

Name

First

Last

Your Home Phone Number:

Cell number:

Your email address (please write it carefully):

Briefly describe why you would like to join our Board of Directors/Executive:

Your current organizational affiliations (names of the organization and your role(s):

Which position on the Board would you like to apply for? Check those that apply:

Other skill(s) of yours that you would like to utilize?

If you join the Board/Executive, you agree that you can provide at least 2-4 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict-of-interest in participating on the Board.

What would you like to get for yourself out of your participation on the Board/Executive, e.g., what types of experiences, skills to develop, interests to cultivate for you, etc.?

Your signature:

Date

If you are not selected as a member of the Board, or if you decide not to join, would you like to be a volunteer to assist our association in various ways that match your skills and interests?

Yes

Perhaps