Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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If elected to a position on the Southwest Kids’ Cancer Foundation’s Board or as a committee member, please indicate where your skills and experience would be best utilized (check all that apply). *

Fundraising

Finance

Corporate Engagement

Donor Engagement

Community Development

Marketing & Communications

Special Events

Planning

Please acknowledge the following: *

I have read the Board Member Role Description and I understand the commitment of time and resources expected of a Board Member. I understand that I will need to complete a Conflict of Interest, Anti-harassment and Anti- discrimination Policies. I hereby agree and consent to a background check in order to be eligible for the board selection process. I hereby agree and consent to the use of my name and/or photographs by Southwest Kids’ Cancer Foundation and Arizona Camp Sunrise & Sidekicks, for any educational and publicity purposes, either in publications, online, in marketing materials, or on radio and television broadcasts. I waive all claim for compensation for such use.

I agree