Salutation:

Mr. Mrs. Ms. Dr.

First Name:*

Last Name:*

Title:*

Company Name:*

Business Address:*

Address 2:

City:*

State:*

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ZIP:*

Business Phone:*

Business Fax:

Business Email:*

Business Website:

Home Address:

Home Address 2:

City:

State:

Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP:

Home Phone:

Cell:

Home Email:

Preferred Address?

Work Home

Referred By:

Employer Recommendation Friend Co-Worker Family Member News Article Web Search In the Press Received Materials Web Site E-mail Event Colleague Arts & Business Council Newsletter Arts & Business Council Website Arts & Business Council Orientation Arts & Culture Organization Company Event Company Website/Intranet Other

Name of Arts or Cultural Organization:*

Current Operating Budget:*

Number of Current Board Members:*

Date You Joined the Board:*

Please describe the most significant experiences you have had:

Please select the areas in which you have expertise:

Architecture/Space Planning
Legal Affairs
Event Planning
Marketing/Market Research
Financial Accounting/Planning
Organizational Management
Graphic Design
Public Relations
Group/Meeting Facilitation
Real Estate Management
Human Resources Management
Strategic Planning
Information Technology
Team Building/Group Dynamics

Please check the boxes below to confirm you understand our application process:

I will send my resume by email to businessonboard@artsandbusinessphila.org.
The board chair and executive director (or equivalent role) of the arts organization know I am applying to this program.
I understand there is a Business On Board program fee of $1,500, which is due prior to the first session.
I understand I am expected to attend all four training sessions (1.11.13, 2.8.13, 3.22.13, and 5.3.13.)