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Membership Application

Board of Directors

Konocti Senior Support, Inc.

Please click the SUBMIT button below when finished

If you prefer to download the paper version, please click here.

Name of Applicant*



Email Address*

Please describe why you would like to serve on the KSS, Inc. Board:*

Will you be able to attend the Monthly Board meetings?*

Do you have a specific interest in any particular part of our program?*

Please list professional background, technical expertise or specific skills you can bring to KSS, Inc. Board.*

Please list any volunteer Board on which you have served. Please include: Name, Years served, Position held, Active (Y/N)*

Please check if you available to serve on any of these committees?*

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