Board of Directors Statement of Interest Form

Background

Keep California Beautiful is a 501 (c) 3 organization dedicated to inspiring and empowering Californians to preserve and protect the state’s beauty. We seek individuals to serve on the nonprofit board. The typical board year is January-December, but new members may be added at any time if a vacancy occurs. The form should take no more than 15 minutes to complete.

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* 1. Contact Information

First Name

Last Name

Company (if applicable)

Address

City/Town

State/Province

ZIP/Postal Code

LinkedIn Profile Address

Emal Address

Phone Number

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* 2. Secondary Phone

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* 3. Mailing Address if different from above

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 4. Are you affiliated, current or past, with any litter, waste reduction, solid waste, or beautification at the local, state, or national level? If yes, please list the name and location.

Name