Keep Nebraska Beautiful Board of Directors Application Form Personal InformationFull Name(Required) First Last Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) PhoneEmployer InformationEmployer Name(Required) Employer Name Your Title(Required) Your Title employer address(Required) Employer Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Business Email(Required) Business PhoneType of business or organization:(Required)Primary service(s) and area/population served:(Required)Preferred method of contact:(Required)WorkHomeHistory & SkillsPlease list boards and committees that you serve on, or have served on:e.g. business, civic, community, fraternal political professional recreational religious, social. Click on the "+" button to add more lines.OrganizationRole/TitleDates of Service Add RemoveEducation/Training/CertificatesOptional: Have you received any awards or honors that you'd like to mention?How do you feel Keep Nebraska Beautiful would benefit from your involvement on the Board?Skills, experience and interests(Required)Please check all that apply Finance, accounting Nonprofit Experience Program Evaluation Special Events Outreach, advocacy Personnel, Human Resources Community service Public relations, communications Grant writing Administration, management Policy development Education, instruction Fundraising OtherSelect AllIf "other" was selected, please specify:Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of [name of org].Anything else you would like us to know?Consent(Required)If selected to be a member of the Board, you agree that you can provide at least 2 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict of interest in participating on the Board. Additionally, Board Members are expected to join Keep Nebraska Beautiful with a $50.00 membership to support the organization's mission and operations. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.(Required)Full Name(Required) First Last KNB Board Appliation Personal InformationFull Name(Required) First Last Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email(Required) PhoneEmployer InformationEmployer Name(Required) Employer Name Your Title(Required) Your Title employer address(Required) Employer Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Business Email(Required) Business PhoneType of business or organization:(Required)Primary service(s) and area/population served:(Required)Preferred method of contact:(Required)WorkHomeHistory & SkillsPlease list boards and committees that you serve on, or have served on:e.g. business, civic, community, fraternal political professional recreational religious, social. Click on the “+” button to add more lines.OrganizationRole/TitleDates of Service Add RemoveEducation/Training/CertificatesOptional: Have you received any awards or honors that you'd like to mention?How do you feel Keep Nebraska Beautiful would benefit from your involvement on the Board?Skills, experience and interests(Required)Please check all that apply Finance, accounting Nonprofit Experience Program Evaluation Special Events Outreach, advocacy Personnel, Human Resources Community service Public relations, communications Grant writing Administration, management Policy development Education, instruction Fundraising OtherSelect AllIf "other" was selected, please specify:Please list any groups, organizations or businesses that you could serve as a liaison to on behalf of [name of org].Anything else you would like us to know?Consent(Required)If selected to be a member of the Board, you agree that you can provide at least 2 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict of interest in participating on the Board. Additionally, Board Members are expected to join Keep Nebraska Beautiful with a $50.00 membership to support the organization’s mission and operations. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.(Required)Full Name(Required) First Last
