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Board
Member Application
Name
___________________________________
Date ______________________
Address_________________________________________________________________________
Telephone (Home)
_______________________ (Work) __________________________
E-Mail
Address ________________________________________
Occupation
____________________________________________
The CILNM Board of Directors meets approximately six times per year on alternate
months on the third Thursday at 2:00 p.m. In
addition there may be committee and/or community work which you will be involved
in which will pose a larger time commitment. Can you make this commitment to
CILNM?
_________________________________
Briefly describe why you wish to serve on the CILNM Board of Directors:
Briefly
describe your experience with disability:
Please Print,
Complete and Mail To:
CILNM
1101 East 37th Street (Mesabi Mall) Suite 25
Hibbing MN 55746
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