Candidate Statement of Intent Form For the North Farm Cooperative Board of Directors [FrontPage Save Results Component] Name: Phone: E-mail Address: Fax: Address: Member Affiliation (buying club or retail name and customer #): Education: Please check all boxes that apply to your experience. Business Planning Personnel Administration Financial Planning Wholesale Grocery Experience Prior or current Board of Director/Civic Office Experience Cooperative Outreach (including co-op theory, issues, development, structure, activities) Community Development Business Management Policy Development Clerical/Interpersonal Skills (report writing/record keeping/communication) Summarize the above experiences: If your work/life experiences feature additional expertise other than the boxes checked above, please summarize here: I declare as a Candidate for: (check only one box) At-Large Rep Chapter Rep (chapter:) Alternate (chapter: ) I am willing to attend up to 6 week-end board meetings and 3 conference calls per year, and fulfill other responsibilities of the position. Signature Date Statement of view concerning future direction of North Farm, and/or any other Board/Membership concerns you wish to comment on (please limit to 300 words please): If you have any questions, please contact Dottie Dykstra (800-236-5880 ext. 2666).
Name: Phone:
E-mail Address: Fax:
Address:
Member Affiliation (buying club or retail name and customer #):
Education:
Please check all boxes that apply to your experience.
Summarize the above experiences:
If your work/life experiences feature additional expertise other than the boxes checked above, please summarize here:
I declare as a Candidate for: (check only one box)
At-Large Rep
Chapter Rep (chapter:)
Alternate (chapter: )
I am willing to attend up to 6 week-end board meetings and 3 conference calls per year, and fulfill other responsibilities of the position.
Signature Date
Statement of view concerning future direction of North Farm, and/or any other Board/Membership concerns you wish to comment on (please limit to 300 words please):
If you have any questions, please contact Dottie Dykstra (800-236-5880 ext. 2666).