Senator Johnson's Senior Advisory Board Registration Form

Name *

Phone number
*

Address
*

Age (55+)
*

Are you a member of any current community boards?

*

What community issues would you like to see addressed?

*

Are you able to meet once a month?

*

Yes

No

Why would you like to join State Senator Johnson's Senior Advisory Board?

*

email resume to shanale@senatoradrianejohnson.com subject: Senior Advisory Board Resume (optional)