Name:
___________________________________________________________________________
Home Address:
___________________________________________________________________________
School Address:
___________________________________________________________________________
Position:
___________________________________________________________________________
Congressional District: Home ( 1 2 3 4 ) Work ( 1 2 3 4 )
___________________________________________________________________________
Home Phone:
___________________________________________________________________________
Cell Phone:
___________________________________________________________________________
Email Address ( Home ) :
___________________________________________________________________________
School:
___________________________________________________________________________
Why would you like to serve on the ACSS Board?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
What else would you like for us to know about you?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Our meetings are held four times a year ( Jan/Feb, May, August and Nov.) Can you commit to at least attending three of these meetings?
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
