Public Library Board Member Report Form - 2013

This is the Board Member Report Form to identify your library board members as of May 1, 2013.

Please complete this form by June 18, 2013.

Please make sure you supply complete current mailing addresses for each member.

Guidelines to help you fill out this form.

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Library Information

Library name*
Director*
Library email*
Are all board positions filled?* Yes
No
If not, how many positions are unfilled?

Trustee Information

Please list the names of the trustees' who will be, and are serving on the board for the year 2013. Provide complete current mailing addresses for each trustee (board member). Please complete the President, Vice-President, Secretary, and Treasurer members, followed by the rest of the trustees. If the system representative is also a board member, please list the information here as well. Systems use this information to correspond with trustees so it is important to have the correct information listed.
Name of trustee 1*
Position*
Mailing address*
City*
Zip*
Home phone*
Email

(Explain board position and dates of term)

(Explain first and second terms)

(Explains if trustee is filling a term for another board member)

Is this member serving* First full term
Second full term
Filling unexpired term
If filling unexpired term, please list Name of person trustee 1 replaced
Current term expires in* 2014
2015
2016
2017


Name of trustee 2*
Position*
Mailing address*
City*
Zip*
Home phone*
Email
Is this member serving* First full term
Second full term
Filling unexpired term
If filling unexpired term, please list name of person trustee 2 replaced
Current term expires in* 2014
2015
2016
2017


Name of trustee 3*
Position*
Mailing address*
City*
Zip*
Home phone*
Email
Is this member serving* First full term
Second full term
Filling unexpired term
If filling unexpired term, please list Name of person trustee 3 replaced
Current term expires in* 2014
2015
2016
2017


Name of trustee 4*
Position*
Mailing address*
City*
Zip*
Home phone*
Email
Is this member serving* First full term
Second full term
Filling unexpected term
If filling unexpired term, please list Name of person trustee 4 replaced
Current term expires in* 2014
2015
2016
2017


Name of trustee 5*
Position*
Mailing address*
City*
Zip*
Home phone*
Email
Is this member serving* First full term
Second full term
Filling unexpired term
If filling unexpired term, please list Name of person trustee 5 replaced
Current term expires in* 2014
2015
2016
2017


Name of trustee 6
Position
Mailing address
City
Zip
Home phone
Email
Is this member serving First full term
Second full term
Filling unexpired term
If filling unexpired term, please list Name of person trustee 6 replaced
Current term expires in 2014
2015
2016
2017


Name of trustee 7
Position
Mailing address
City
Zip
Home phone
Email
Is this member serving First full term
Second full term
Filling unexpired term
If filling unexpired term, please list Name of person trustee 7 replaced
Current term expires in 2014
2015
2016
2017


System Representative Information

Explain what the System Representative is


Who is the designated system representative for the library's regional system? This is usually the director or a board member but may be an interested third party.


Your library's System Representative name: who will attend the full NCKL System Board Meeting on August 1, 2013*
Mailing address
City
Zip
Home phone
Email
Additional comments

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Last updated June/07/2013

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