EmailMe Form - 2015 WBW Company Advisor Application

Information on our Volunteer Programs can be found at: http://www.wbw.org/Reader.aspx?pg=Volunteer_CompanyAdvisors.htm

Please Note: This form uses ReCaptcha (TM) technology to keep your information safe and strictly confidential.

VOLUNTEER GENERAL INFORMATION

Volunteer Name *

First Last

Employer - Organization *

Job Title *

Mailing Address *

Home address

Work address

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Work Phone *

### - ### - ####

Cell Phone *

### - ### - ####

Fax Number

### - ### - ####

Email *

Gender *

Male

Female

Ethnicity
(for statistical purposes only) *

Polo Shirt Type *

Men

Women

Polo Shirt Size *

Choose the university you want to attend (1 and 2) in order of preference.

1st Choice *

Western (Bellingham) June 20-27

Gonzaga (Spokane) July 11-17

Central (Ellensburg) July 25-August 1

PLU (Tacoma) August 8-15

2nd Choice *

Western

Gonzaga

Central

PLU

Please note that your program starts one day sooner than the students due to a mandatory training for advisors.

Choose the program or pathway you want to mentor (1 and 2) in order of preference.

Program or Pathway
1st Choice *

Program or Pathway
2nd Choice *

OTHER INFORMATION

As a CA I hope to accomplish *

Three words that describe me are:

One *

Two *

Three *

Is there anything else you want to tell us?

LODGING

I will be staying at (hotel/dorm) *

My emergency contact # is *

### - ### - ####

THANK YOU LETTERS

THANK YOU LETTERS *

A thank you letter to my employer for my participation is not required.

Please send my employer a thank you letter for allowing me to participate in this program.

Name of person receiving letter

Title of person receiving letter

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

ADVISOR FEE PAYMENT INFORMATION

You will not be charged or invoiced for the registration fee of $325 until your application has been accepted (after April 15).

Payment *

Please send me an invoice for the $325 advisor fee.

Please charge my credit card for the $325 registration fee.

Other

Credit Card

VISA

Mastercard

Discover

AMEX

Account Number

Expiration Date

Security Code

Name on Card

Billing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

CONSENT TO BACKGROUND CHECK

(REQUIRED)

I CONSENT TO A CRIMINAL BACKGROUND CHECK.
(Digital signature) *

(NAME - First, MI, Last)

Date of Birth *

MM / DD / YYYY

Date *

MM / DD / YYYY

Washington Business Week and the Pathways are programs of The Foundation for Private Enterprise Education 501(c)(3). We provide equal opportunity to participate in all the rights, privileges, and activities sponsored by the organization regardless of the participant’s race, color, sex, national or ethnic origin, religion, or sexual orientation. The Foundation does not discriminate in the administration of its educational scholarship policies and strives to provide every participant full opportunity of participation in all scheduled activities.