Contact Information for Board Candidates/Members

Disclaimer:

Please note that Luke's Place collects the information on this form only for the purposes of board recruitment.

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* 1. Contact Information:

First Name:

Last Name:

City/Town of Residence:

Email Address:

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* 2. Telephone Numbers:

Home:

Work:

Cell:

Fax:

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* 3. Are you 18 years of age or older?

Yes

No

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* 4. Profession:

Profession:

City/Town of Work:

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* 5. Preferred Time and Location for Telephone Calls

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* 6. Interested individuals also need to submit a letter of interest and resume/CV to admin@lukesplace.ca to complete their application. Please acknowledge your intent to submit.

Yes