| First Name: |
|
| Last Name: |
|
| Address Street 1: |
|
| Address Street 2: |
|
| City: |
|
| Zip Code: |
(5 digits) |
| State: |
|
| Daytime Phone: |
|
| Evening Phone: |
|
| Email: |
|
| I agree to receive the Brandeis Beat Via email. Check one: |
Yes |
| |
No |
Career Experiences:
Hobbies/Special Interest/Skills that you would like to share with us: |
|
| Affiliation in the community (professional, philanthropic, corporate, civic:0 |
|
|
Get Involved with Brandeis:
Have you ever led a study group or workshop?
|
Yes |
| |
No |
| Would you like to be trained to lead a stoudy group? |
Yes |
| |
No |
| Are your family Members willing to share their expertise? |
Yes |
| |
No
|
| Are you a part of the Boomer Generation? |
Yes |
| |
No |
| Please indicate one or more committees in which you could be interested in participating: |
Check Boxes Below
|
|
Book & Author event |
| |
Luncheon Committees |
| |
Programming |
| |
Publicity |
| |
Bookstore Staff |
| |
Hospitality |
| |
Community Service |
| |
Internet |
| |
Bulletin |
| |
Study Groups |
| |
Fundraising Projects |
| |
Membership Team |
| |
Special Events |
| CONTACTS: Whom do you know? Check as many areas in which you would like to help: |
|
| |
Speakers |
|
Theater |
| |
Performers |
| |
Restaurants |
| |
Media |
| |
Club House |
| |
Food Products |
| |
Transportation |
| |
Paper Goods |
| Can you donate or obtain gift items or services for events? |
Yes |
| |
No |
| Would you provide transportation to events for non-drivers? |
Yes |
| |
No |
|
Thank you for your valuable input.
|
Selma Ost selmasost@aol.com
623-869-0909
3038 W. Trapanotto Rd.
Phoenix, AZ 85086
|
|
|
