Board | Leadership Dixie

Name *

First

Last

Email *

Mobile Phone *

Work Phone *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employer *

Years living in Washington County *

What year did you graduate from Leadership Dixie? *

Have you applied to the Leadership Dixie Board before? *

Yes
No

If so, when did you apply? *

Have you served on the Leadership Dixie Board before? *

Yes
No

If yes, when did you serve on the Board?

Community Leadership in the Past 5 Years *

Describe present and past volunteer community leadership positions you have held. Organization, Positions/Responsibilities, Dates

What special qualities or qualifications do you have that will add to the diversity of the Leadership Dixie Board? *

Recent Head Shot Photo *

Click or drag a file to this area to upload.

Please upload a recent head shot of yourself. This photo will be used in the class member directory.
Allowed file types: .jpg, .jpeg, .png,
Max file size: 10 MB

Required Consent *

I have read and agree to the statements below

Any Director who has three (3) unexcused absences for attendance at a regular Board meeting within a rolling twelve (12) month period may be removed from the Board upon the affirmative vote of a majority of the Board.

Board Directors must attend in full the initial Retreat Day and Graduation in support of the class and program.

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BOARD OF DIRECTORS APPLICATION