Application for Board Membership
QC Plus 60 Club
|Address:||Street:||City, St, Zip:|
|Home Phone:||Cell Phone:|
|Retired:||Yes _____ No _____||Where employed:|
|Plus 60 Member:||Yes _____ No _____||If yes, how long?|
Plus 60 activities in which you have participated:
List organizations/clubs and offices/committees in which you have served:
Office held or Committee
What experiences or interests could you contribute to the Plus 60 Board?
Why would you like to serve as a Plus 60 Board member?
Thank you for considering membership on the Plus 60 Board.
Please return the completed form by mail or e-mail to:
Dick Stoltz, 411 4th Ave. West, Andalusia, Illinois 61232
Questions? please call Dick @ 309-798-2140