Board of Directors Application

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1. Board of Directors

Board of Directors   Name:
Address:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP:
Email Address:
Phone Number:

2. I am interested in the following positions for the 2009- 2010 season.

	1st Choice	2nd Choice	3rd Choice	4th Choice	5th Choice
Vice-President Treasurer	*I am interested in the following positions for the 2009- 2010 season. Vice-President Treasurer 1st Choice	Vice-President Treasurer 2nd Choice	Vice-President Treasurer 3rd Choice	Vice-President Treasurer 4th Choice	Vice-President Treasurer 5th Choice
Vice President House and House Travel Hurricanes Division	Vice President House and House Travel Hurricanes Division 1st Choice	Vice President House and House Travel Hurricanes Division 2nd Choice	Vice President House and House Travel Hurricanes Division 3rd Choice	Vice President House and House Travel Hurricanes Division 4th Choice	Vice President House and House Travel Hurricanes Division 5th Choice
Vice President Flames Division	Vice President Flames Division 1st Choice	Vice President Flames Division 2nd Choice	Vice President Flames Division 3rd Choice	Vice President Flames Division 4th Choice	Vice President Flames Division 5th Choice
Secretary	Secretary 1st Choice	Secretary 2nd Choice	Secretary 3rd Choice	Secretary 4th Choice	Secretary 5th Choice
House Registrar	House Registrar 1st Choice	House Registrar 2nd Choice	House Registrar 3rd Choice	House Registrar 4th Choice	House Registrar 5th Choice
Flames Registrar	Flames Registrar 1st Choice	Flames Registrar 2nd Choice	Flames Registrar 3rd Choice	Flames Registrar 4th Choice	Flames Registrar 5th Choice
Equipment Director	Equipment Director 1st Choice	Equipment Director 2nd Choice	Equipment Director 3rd Choice	Equipment Director 4th Choice	Equipment Director 5th Choice
Ice Director	Ice Director 1st Choice	Ice Director 2nd Choice	Ice Director 3rd Choice	Ice Director 4th Choice	Ice Director 5th Choice
Special Events Director	Special Events Director 1st Choice	Special Events Director 2nd Choice	Special Events Director 3rd Choice	Special Events Director 4th Choice	Special Events Director 5th Choice
Fund-raising Director	Fund-raising Director 1st Choice	Fund-raising Director 2nd Choice	Fund-raising Director 3rd Choice	Fund-raising Director 4th Choice	Fund-raising Director 5th Choice
Sponsors Director	Sponsors Director 1st Choice	Sponsors Director 2nd Choice	Sponsors Director 3rd Choice	Sponsors Director 4th Choice	Sponsors Director 5th Choice
House Referee-in-Chief Director	House Referee-in-Chief Director 1st Choice	House Referee-in-Chief Director 2nd Choice	House Referee-in-Chief Director 3rd Choice	House Referee-in-Chief Director 4th Choice	House Referee-in-Chief Director 5th Choice
Travel Referee-in-Chief Director	Travel Referee-in-Chief Director 1st Choice	Travel Referee-in-Chief Director 2nd Choice	Travel Referee-in-Chief Director 3rd Choice	Travel Referee-in-Chief Director 4th Choice	Travel Referee-in-Chief Director 5th Choice
House Director Intro-Mites – Mites	House Director Intro-Mites – Mites 1st Choice	House Director Intro-Mites – Mites 2nd Choice	House Director Intro-Mites – Mites 3rd Choice	House Director Intro-Mites – Mites 4th Choice	House Director Intro-Mites – Mites 5th Choice
House Director – Squirts, Peewees	House Director – Squirts, Peewees 1st Choice	House Director – Squirts, Peewees 2nd Choice	House Director – Squirts, Peewees 3rd Choice	House Director – Squirts, Peewees 4th Choice	House Director – Squirts, Peewees 5th Choice
House Director – Bantams, Midgets	House Director – Bantams, Midgets 1st Choice	House Director – Bantams, Midgets 2nd Choice	House Director – Bantams, Midgets 3rd Choice	House Director – Bantams, Midgets 4th Choice	House Director – Bantams, Midgets 5th Choice
Travel Director – Mites, Squirts. Peewees	Travel Director – Mites, Squirts. Peewees 1st Choice	Travel Director – Mites, Squirts. Peewees 2nd Choice	Travel Director – Mites, Squirts. Peewees 3rd Choice	Travel Director – Mites, Squirts. Peewees 4th Choice	Travel Director – Mites, Squirts. Peewees 5th Choice
Travel Director – Bantams, Midgets	Travel Director – Bantams, Midgets 1st Choice	Travel Director – Bantams, Midgets 2nd Choice	Travel Director – Bantams, Midgets 3rd Choice	Travel Director – Bantams, Midgets 4th Choice	Travel Director – Bantams, Midgets 5th Choice
Vice President, Girls Program	Vice President, Girls Program 1st Choice	Vice President, Girls Program 2nd Choice	Vice President, Girls Program 3rd Choice	Vice President, Girls Program 4th Choice	Vice President, Girls Program 5th Choice
Coaching Director – House	Coaching Director – House 1st Choice	Coaching Director – House 2nd Choice	Coaching Director – House 3rd Choice	Coaching Director – House 4th Choice	Coaching Director – House 5th Choice
Coaching Director – Travel	Coaching Director – Travel 1st Choice	Coaching Director – Travel 2nd Choice	Coaching Director – Travel 3rd Choice	Coaching Director – Travel 4th Choice	Coaching Director – Travel 5th Choice

3. Please list any children in League: (Name & Division):

Please list any children in League: (Name & Division):

4. Please tell us why you would be a good addition to the Board of Directors. Be sure to list any experience, strength, and skills you can offer that qualifies you for a particular position.

Please tell us why you would be a good addition to the Board of Directors. Be sure to list any experience, strength, and skills you can offer that qualifies you for a particular position.

5. Have you ever been arrested or convicted of a sexual assault or related offense as defined in NH RSA 632-A which has not been annulled (or similar offense in another state)?

Have you ever been arrested or convicted of a sexual assault or related offense as defined in NH RSA 632-A which has not been annulled (or similar offense in another state)?   Yes No