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LGBT Center of Raleigh: Board Member Application
All information gathered in the processing of this Board application will be held in strict confidentiality.
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Email
*
Your email
Full Legal Name
*
Please be informed and understand that all applicants are subject to a background check which requires your legal name. (If you have any questions concerning this process please email
Dgoldenburg@lgbtcenterofraleigh.com
)
Your answer
Preferred Name / Nickname
If you are known by or preferred to go by a name other than your legal one presented above please indicate so here.
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Pronouns
*
Your answer
Primary Phone
*
Your answer
Secondary Phone
Your answer
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