Little Theatre of Manchester Board Member Information Form

Please fill out the following form. Information will be kept confidential, and only used for reporting purposes. For internal purposes we will prepare a board list that includes this information.

Name

First Name

Last Name

Preferred Salutation

Mrs.

Mr.

Miss

Spouse/Partner Name

Preferred E-Mail Address

Secondary E-Mail Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Employer Name

Title or Occupation

Please list other Boards on which you currently serve:

Little Theatre Board committee(s) on which you would be interested in serving:

Governance

Finance

Fund Development/Gala

Little Theatre of Manchester Board Member Information Form

Contact

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