Settlement Club Member Profile & Placement Form - The Settlement Home for Children

Member's Full Name:*

Email:*

Cell Phone Number:

Home Phone Number:

Home Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Employer:

Job Title:

Spouse/Partner's Full Name:

Your Garage Sale Department:

Current Cottage Committee:

(Only if applicable)

Please list other club committees, both past and present:

Please list other organizations you volunteer with, and include your title if you hold a position:

Please select any skills or talents that apply to you:

You are welcome to select as many as apply to you.

If you selected other, please list your skills here:

Leadership Opportunities

Please consider the following leadership opportunities and check any that you might be interested in.

Executive Committee:

Check as many placement preferences as you are interested in.

Board of Directors:

Check as many placement preferences as you are interested in.

Non-Board Positions:

Check as many placement preferences as you are interested in.

I would like to serve on a Garage & Estate Sale committee:

I would like to serve on a Shining Star Gala committee:

I would like to serve on a Cottage committee:

I would like to host a meeting in my home:

I would like to chair a hostess committee for one of the general meetings:

I would consider making pick-ups from Garage & Estate Sale donors: