Board Application* All fields on this application are required. Contact InformationName *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail *Phone *Tell Us About YouHave you ever served on a board of directors of a non-profit agency or organization? If yes, please describe, including dates served or term serving currently. *Have you held other leadership positions in community organizations? If yes, please describe, including dates served or term serving currently. *With what do you fill your spare time - (hobbies, interests, community involvement)? *Have you had prior involvement with Allentown Public Theatre (APT)? If yes, please describe. Are you willing to serve if elected to the Board of Directors of Allentown Public Theatre? *YesNoCurrently, our monthly board meetings are held on a weeknight, once a month (typically but not always at 7:00 pm). Would you generally be able to attend at that time? *YesNoBecause Allentown Public Theatre interacts with children, all board members are required to submit to Pennsylvania or National criminal/child abuse background checks. Are you willing to initiate and pay for such checks if you are elected to serve? *YesNoBoard members are asked to serve on committees dealing with issues of finance, marketing, fundraising, outreach, technical, program development, box office, etc. What do you anticipate would be your primary contribution(s) to the board’s committees? *On which committee(s) would you wish to serve if elected? *Board members are expected to take part in fundraising efforts. APT will conduct various types of fundraising activities, to which each board member contributes in accordance with his/her skills and talents. What experience do you have with fundraising? *If elected, are you willing to participate in fundraising activities and in occasional brief training sessions to hone your skills? YesNoBoard Members are expected to make a personally meaningful contribution annually. For some, that might mean $100 or $250; to others, $1,000 or more. The amount is a personal decision. If elected, are you willing to make such a donation? *YesNoWhat are your reasons for wanting to be on the Board of Directors of Allentown Public Theatre? *What else would you like us to know about you that would be relevant to our considerations? VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: