Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your primary residence in Nova Scotia? *

Yes, my primary residence is in Nova Scotia

No, I am not a resident of Nova Scotia

Have you worked or volunteered with a L'Arche community before? *

Yes

No

Skills and Interests *

I would like to participate in the following areas of the board's work and responsibilities:

Record-taking and Organization

Policy, Governance and Legal

Identity & Mission

Risk Management and Insurance

Infrastructure and physical assets (maintenance and new)

Finance and Financial Reporting

Development of revenue and resources

Public Relations and Communications

Outreach and Community Events

Health and wellness

Other: