SMLD Board Application

Please print, complete information below, and return to:

Nominating Committee, c/o SMLD Office, 5 Monument Square, Portland, ME 04101

Name (Mr. Mrs. Ms.) ______________________________________________

Employment _____________________________________________________

Title _____________________________________

Mailing Address __________________________________________________

Daytime Phone ___________________Evening Phone ___________________

Email __________________________________________________________

Previous Position ________________________________________________

Resume Enclosed Yes ____ No ____

Name of Library _________________________________________________

Education ______________________________________________________

Library School ___________________________________________________

Library Affiliations and Memberships

______________________________________________________________

Other Information of Interest (publications, awards, etc.)

______________________________________________________________

I want to serve on the SMLD board because…

______________________________________________________________

Rev. 2/17/06