Advisory Board Application 2009

City of Dunn Police Athletic/Activities League 610 East Johnson St. / Post Office Box 1065 Dunn, N.C. 28335 Office 910-892-1873 / Fax 910-892-9962 www.dunnpal.org FILLING PLAYGROUNDS, NOT PRISON’S

Advisory Board Application Date: ________________ Name: _____________________________________________ Date of Birth: __________________ Address: _____________________________________________________ City: ________________ State: _____ Zip: ________ Home Phone#: ___________ Cell# _____________Work# ___________ Social Security Number: ____-_____-________ Sex: ________ Race: _________ Place of Employment: _______________________________________ City: ___________ Any prior Criminal Record? (circle one) YES / NO If yes, please describe: _________________________________________________________________ ____________________________________________________________________________________ Your reason for applying for an Advisory Board Position? _____________________________________ ____________________________________________________________________________________ What can you bring to the board that will help PAL and the youth? ______________________________ ____________________________________________________________________________________ Do you have any prior fundraising experience? (circle one) YES / NO If yes give location/organization and what type of experience you have: __________________________ ____________________________________________________________________________________ Give number of years you will be willing to serve on the board: ______ years. Give what positions you are willing to accept on the board (president, VP, secretary, etc.) ____________________________________________________________________________________ Please state any other experience and/or comments you may have: ______________________________ ____________________________________________________________________________________ Applicant signature: __________________________________ Date: ___________________________ Wittness: _________________________________________ Date: ____________________________ Board Use only: Approved / Rejected Date: ___________ Term exp. _____________ Board Positions and years since approval: ___________________________________________________ _____________________________________________________________________________________ Director Lt. R. W. Rowland Advisory Board Executive Director - Chief of Police B. P. Jones President – Bryan Galbreath Vice President – Kareen Teasley Secretary – Millicent Massey