| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| I agree to receive the Brandeis Beat Via email. Check one: |
Yes |
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No |
Career Experiences:
Hobbies/Special Interest/Skills that you would like to share with us: |
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| Affiliation in the community (professional, philanthropic, corporate, civic:0 |
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Get Involved with Brandeis:
Have you ever led a study group or workshop?
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Yes |
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No |
| Would you like to be trained to lead a stoudy group? |
Yes |
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No |
| Are your family Members willing to share their expertise? |
Yes |
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No
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| Are you a part of the Boomer Generation? |
Yes |
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No |
| Please indicate one or more committees in which you could be interested in participating: |
Check Boxes Below
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Book & Author event |
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Luncheon Committees |
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Programming |
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Publicity |
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Bookstore Staff |
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Hospitality |
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Community Service |
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Internet |
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Bulletin |
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Study Groups |
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Fundraising Projects |
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Membership Team |
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Special Events |
| CONTACTS: Whom do you know? Check as many areas in which you would like to help: |
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Speakers |
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Theater |
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Performers |
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Restaurants |
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Media |
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Club House |
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Food Products |
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Transportation |
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Paper Goods |
| Can you donate or obtain gift items or services for events? |
Yes |
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No |
| Would you provide transportation to events for non-drivers? |
Yes |
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No |
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Thank you for your valuable input.
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Sue Rollins 480-563-0411
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