SixTwelve Board Information Form

Dear SixTwelve Board Member,

Please fill out this form at your earliest convenience. This will aid us in keeping track of your information for grant applications, bank compliance and just keeping in touch. Thank you!

Name *
Name
Address *
Address
Birthday *
Birthday
Cell Phone or Home Phone *
Cell Phone or Home Phone
Please enter the phone number you would like us to use to contact you.
Please include a brief bio so that we may update our website. Thank you!
Start Date for serving the 612 board. (You may enter March 27, 2019 if you are a new board member.) *
Start Date for serving the 612 board. (You may enter March 27, 2019 if you are a new board member.)