The Auxiliary Board of Center for Conflict Resolution

2017Prospective Member Application

Each question must be answered completely before this application is reviewed and considered. Please submit this form and include one letter of recommendation (if possible). All completed prospective member applications should be submitted to Meredith Mann, Development Director by email at .

Home Information

Candidate’s Name:

Home Address:

City, State, Zip:

Home Phone:Home Fax:

Cell Phone:

Home Email:

Business Information

Employer:

Business Address:

City, State, Zip:

BusinessPhone:Business Fax:

Business Email:

Occupation/Title:

Industry

 Accounting

 Advertising

 Consulting

 Consumer Products

 Education

 Financial Services

 Food & Beverage

 Healthcare

 Hospitality

 Law

 Manufacturing

 Marketing/PR

 Real Estate

 Services

 Technology

 Telecommunications

 Travel

 Other: ______

Business Environment

 Corporate Small Business

 Self-employed

 Other: ______

Personal Information

Number of years you have lived in Chicago:

College Attended:

Graduate School Attended:

What are your interests, hobbies and/or skills?

Personal connections who may be helpful to the objectives of the Auxiliary Board:

Auxiliary Board Information

Please provide the names of individual(s) whoyou know on the board (if applicable):

What aspects of CCR interest you most and why?

How did you learn about the Auxiliary Board?

 Current or Past Auxiliary Board Member Friend/Business Associate

 Member of Board of Directors Other

 Attendance at events

Why would you like to join the Auxiliary Board of the Center of Conflict Resolution as opposed to other Boards in the Chicago area?

Please list the Auxiliary Board events or other CCR functions you have attended and their years.

Are there any Auxiliary Board/CCR events/activities/committee types with which you are particularly eager to become involved? Why?

Are you interested in serving in a leadership role on the Auxiliary Board (ie. serving in a Vice-Chair role)?

Please list any other volunteer organizations or trade associations with which you have been involved and the capacity in which you served. (Also, please indicate any on which you continue to serve.)

OrganizationCapacityYear(s) Served

Do you have any special talents, experience, or affiliations that might be of use to the Auxiliary Board?

 Corporate Funding Contacts

 Event Planning Experience

 Food & Beverage Contacts

 In-Kind Goods/Services Contacts

 Marketing/PR Contacts

 Related Education

 Sales/Telemarketing Experience

 Volunteer Experience

 Other:______

Who on the Board have you met or know personally?

I have reviewed the Active Member Requirements and I understand what will be expected of me should I be accepted to the Auxiliary Board. I am willing and able to invest my time, resources, and contacts to support the Auxiliary Board and its activities. I understand that a position on the Auxiliary Board is an important responsibility, and I will do all I can to support my role.

Sign or Type Name: ______Date: ______