Please complete this application form if you are interested in becoming a Bruce Museum Youth Committee Member. Once you complete the form, click the submit button at the bottom.

Name and address

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Date of birth:

Age:

Gender:

Education:

Referral Source:

Emergency Contact

Who can we contact in case of an emergency?

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Why are you interested in serving on a committee

Briefly tell us when, why and how you would like to serve on a youth committee for a arts and science museum. Also, in the comment section, tell us what days and times of the week are more convenient for you to attend committee meetings.

My availability is:

From:

to:

Briefly tell us why you are interested in being a member of the Youth Committee.