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Board Member Biographical Info
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* Indicates required question
First Name
*
Your answer
Last Name:
*
Your answer
When is your birthday?
*
Please provide the Month and Day
MM
/
DD
Spouse's Full Name
Your answer
The following questions are used solely to provide statistical information about our Board of Directors
Ethnicity
*
Hispanic
Not Hispanic
Required
Race
*
Check all that apply
American Indian / Alaskan Native
Asian
Black / African American
Native Hawaiian / Other Pacific Islander
White
Required
Gender
*
Check all that apply
Female
Male
Non-Binary
Transgender
Intersex
Other:
Required
Are you a senior? (over 55 years)
Yes
No
Are you a Veteran?
*
Yes
No
Does not apply
Required
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