Member Name *

Member Number *

Address *

Home Phone Number *

Office Phone Number

Cell Phone Number *

E-mail Address *

List any ECC committees or associations of which you are or have been a member.

List any club-within-a-club in which you have participated.

List any community organizations in which you have or have held membership and/or position:

List present occupation, length of tenure, title or present position and brief description of duties and responsibilities:

Why do you want to serve on the Board of Governors?

I understand that as a member of the ECC Board of Governor, that my tenure will be a three-year term. I also understand that the regularly scheduled meeting of the Board is the first Thursday of the month. *