Youth Committee 2014 - 2015
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:
Choose
AK
CA
CT
DC
FL
IL
MA
MD
MI
NH
NJ
NM
NY
PA
VA
*
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:
Month
Jan
Feb
Mar
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Jul
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Dec
Day
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1922
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1918
1917
*
Age:
*
Gender:
Choose
Female
Male
*
Education:
Choose
College Graduate
College Student
Doctoral Level Degree
Elementary School Student
High School Graduate
High School Student
Law Degree
Masters Degree
Middle School Student
Some College
*
Referral Source:
Choose
Community Organization
Family Member
Fridays-In-The-Round
Friend
Girl Scouts
Greenwich High School
Museum Committee
Museum Event
Museum Publication/Letter
Museum Staff
Museum Store
Museum Volunteer
Newspaper
Other
Parent
School
Self Initiated
Television
The Volunteer Center
Website
*
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:
Choose
Agency Contact
aunt
brother
Colleague - Work
Co-worker
Daughter
Employer / Supervisor
Father
Friend
Guardian
husband
Mentor
Mother
Museum Staff
Neighbor
Other
Parent
Parent-mother
Partner
Physician
Relative
School Contact
Scout Leader
Self
Sibling
sister
Son
Spouse
Supervisor
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:
Choose
Afternoon
Anytime
Evening
Morning
Temporarily Inactive
Weekday
Weekend
*
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
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4
5
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31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
*
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
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11
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28
29
30
31
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
*
Briefly tell us why you are interested in being a member of the Youth Committee.
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