Name*Position/Title*Location*Corporate / Central RegionBirmingham, AL / Central RegionCarbon Hill, AL / Central RegionCullman, AL / Central RegionDothan, AL / Central RegionEvergreen, AL / Central RegionFlorence, AL / Central RegionLeroy, AL / Central RegionMobile, AL / Central RegionMontgomery, AL / Central RegionOxford, AL / Central RegionRobertsdale, AL / Central RegionScottsboro, AL / Central RegionTuscaloosa, AL / Central RegionPanama City, FL / Central RegionPensacola, FL / Central RegionTallahassee, FL / Central RegionValparaiso, FL / Central RegionAthens, GA / East RegionAtlanta North Metro, GA / East RegionAtlanta South Metro, GA / East RegionAugusta, GA / East RegionBainbridge, GA / Central RegionBrunswick, GA / East RegionCollege Park, GA / East RegionColumbus, GA / Central RegionDublin, GA / East RegionGainesville, GA / East RegionJasper, GA / East RegionLawrenceville, GA / East RegionMacon, GA / East RegionMarietta, GA / East RegionMcRae, GA / East RegionMilledgeville, GA / East RegionRome, GA / Central RegionSavannah, GA / East RegionStatesboro, GA / East RegionSylvester, GA / Central RegionValdosta, GA / East RegionWaycross, GA / East RegionWest Point, GA / Central RegionAlexandria, LA / West RegionBaton Rouge, LA / West RegionCrescent City, LA / West RegionLafayette, LA / West RegionLake Charles, LA / West RegionMonroe, LA / West RegionNew Iberia, LA / West RegionShreveport, LA / West RegionGulfport, MS / West RegionHattiesburg, MS / West RegionLaurel, MS / West RegionMcComb, MS / West RegionNatchez, MS / West RegionOcean Springs, MS / West RegionChattanooga, TN / Central RegionCleveland, TN / Central Region Do you currently or have you ever served on the board of a Nonprofit/Charitable, Civic or Governmental Organization ?*Ex: Boy Scouts of America, United Way of Central Al, etc Yes No If you are a current member of multiple organizations, you will have the ability to add additional organizations after completing this form. Organization NameOrganization Type? Charitable Education Government, Chamber Industry Religious Other Location of OrganizationPosition HeldBoard MemberOfficerCommitteeService Status? Past Current Briefly describe the mission of the organization Please list any Civic or Community Initiatives that you are passionate about and briefly describe themList in order of importance in the following format by pressing 'return' after each initative. If you have already submitted initiatives previously, leave this field blank. Environmental: Recycling Women’s Initiatives: Mentoring young women Education: Reading to children at local library CAPTCHA