Name *

In the FIRST NAME field please type your first name then middle initial (John D. )

First Name

Last Name

Birth Date *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

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When filling board positions we look for individuals who bring to the table skills to help us deliver on our mission. Please check those that apply to you - and add any other expertise you would like us to know of.

Public Relations/Marketing

Legal Expertise

Fundraising

Grant Writing

Accounting/Budgeting

Reference 1 Name

First Name

Last Name

Reference 1 Phone

(###)

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Reference 2 Name

First Name

Last Name

Reference 2 Phone

(###)

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Reference 3 Name

First Name

Last Name

Reference 3 Phone

(###)

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WSP BACKGROUND CHECK *

I authorize the Port Angeles Food Bank to conduct a criminal records check. I understand that volunteering at the PAFB is contingent upon receipt of a satisfactory report.

I agree to a WSP background check

RELEASE OF LIABILITY *

The undersigned individual will be engaged in volunteer service in the form of special events, warehouse, office and related duties for The Port Angeles Food Bank of Clallam County. This participation is voluntary on the part of the individual, who hereby releases The Port Angeles Food Bank, its managers, employees, agents, Board of Directors, predecessors, successors, assigns, representatives, attorneys, subsidiaries, and affiliates, and all persons acting by, through or in connection with any of them from any and all claims, liabilities, damages, losses, demands, and actions of any nature whatsoever arising out of the individual’s participation in such duties. Such release extends to any injury, damage, loss or liability incurred by the individual while engaged in such duties, whether occurring on or off the premises owned or operated by The Port Angeles Food Bank.

I Agree to the release of liability as stated above

PHOTO RELEASE *

I grant permission to the Port Angeles Food Bank to take and use photographs and/or digital images of me for use in printed materials or electronic communications. I further agree that my name and identity may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, and digital reproductions shall be the property of the Port Angeles Food Bank.

I Agree to the photo release as stated above

I understand this application is not a guarantee of a position on the board.

I Agree