Member Advisory Board Application Form Date First Name Middle Initial Last Name Birth Date Mailing Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Phone Number Email If employed, who is your current employer? Current Position Please check area(s) of expertise/contribution you feel you can make to further the mission of SAFE FCU. Advocacy Nonprofit Experience Fundraising Strategic Planning Technology Finance/Accounting Personnel/Human Resources Community Service Policy Development Social Media/Communications Education Public Relations Other… Other Please list boards and other committees that you serve on, or have served on (business, civic, community, fraternal, professional, recreational, and social). Please list organization, role/title, and dates of service. Why are you interested in serving as an Advisory Board Member for SAFE FCU? How do you feel SAFE FCU would benefit from your involvement on the Advisory Board?