Trustee Info Form Trustee Profile Form Used to obtain contact information and other helpful data. Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Contact InformationPreferred Email* Mobile PhoneHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone (if applicable)Employer (if applicable)Job Title (if applicable)Business Address (if applicable) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone (if applicable)Name of Administrative Assistant (if applicable) Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Email for Administrative Assistant (if applicable) Please send all mailed correspondence to* Home Address Business Address Other InfoBirthday Date Format: MM slash DD slash YYYY Previous Occupations**In lieu of completing this portion of the form, you may email a recent resume or CV to hmclaren@thevalentine.orgEducationAdditional Board ServiceProfessional/Civic AssociationsSocial Club MembershipsCommunity ActivitiesReligious AffiliationOther InterestsFamilySpouse's Name (if applicable) Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Spouse's Birthday (optional) Date Format: MM slash DD slash YYYY Names and ages of children (if applicable)
