Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone Number *

Country

(###)

###

####

Residential Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any previous board or committee experience?

Yes

No

Areas of interest

Governance & Compliance

Finance & Risk Management

Fundraising & Events

Strategic Planning

Community Engagement

Marketing & Communications

Human Resources

Lived Experience

Board Commitment *

Are you able to commit to attending regular board meetings? - Meetings are typically held once per month and run for approximately 1-2 hours. - On rare occasions, you may be asked to attend emergency or special meetings at short notice. - Meetings may be held in person or online (eg., via zoom)

Yes

Unsure/No

Eligibility Confirmation *

I confirm I am 18 years of age or older

Disqualification Check *

Have you ever been disqualified from acting as a board member or company director?

Yes

No

Insurance Acknowledgement *

I acknowledge that Oldies Angels Inc holds $20 million Public Liability Insurance.

Privacy & Confidentiality *

I understand that any personal information I provide will be treated confidentially and in accordance with relevant privacy laws. It will only be used for purposes relating to this board application and membership.

Declaration *

I declare the information provided is true and correct to the best of my knowledge.

I understand that if appointed to the board, I will be required to maintain the confidentiality of information discussed or shared in relation to board business.

Date Submitted *

MM

DD

YYYY

Full Name (Electronic Signature): *

By typing my full name below, I confirm that the information provided in this application is true and correct to the best of my knowledge. I understand that this typed name is considered my electronic signature for the purposes of this application.

First Name

Last Name