MDF Board of Director Application

Name:

E-mail:

Mailing Address:

City, State, Zip:

Day Phone:

Evening Phone:

Cell:

Occupation:

Business Name:

Business Address:

City, State, Zip :

Education:

Family Members :

For the items below, please answer in the space provided.

1. Business experience you feel would benefit the promotion, expansion and continuation of the MDF.

2. Philosophy regarding the Mule Deer Foundation.

3. Reason for becoming involved with the Foundation.

4. Expertise you would bring to the Foundation.

5. Leadership abilities.

6. Organization affiliations and accomplishments.

PERSONAL OR BUSINESS REFERENCES: Name, address, and phone numbers of a minimum of five references. List persons who have knowledge of your experience and leadership skills.

Conflict of Interest Statement

If you derive some portion of your income from mule deer or their subspecies resources (i.e., Outfitter/Guide, Taxidermy, State Wildlife Agency, etc.) please complete the following:

State in which your business is located:

Business License Number / Guide/Outfitter License Number:

Are you a member in good standing with your State’s Guide/Outfitter Association?
Yes       No

If No, please explain:

I certify by my signature that the above statements have been answered fully and truthfully.

Signature:

Date: