Library Board Membership

A form to collect library board member information

List each trustee who is a member of the library board as of August 1, 2007. As changes occur, please
notify the State Library and the Library Service Area. Indicate new board members with an *. Name
and address information is needed for trustee mailing lists at the State Library and the Library Service
Area.

Be sure to complete the information on the number of board meetings scheduled and workshops/conferences
attended. This information is for the period of July 1, 2006-June 30, 2007, and is not applicable to new Board Members.

NOTE: PLEASE GIVE COMPLETE MAILING ADDRESS OF YOUR BOARD MEMBERS.

City of Library (Required)

Locator Code (Required)

Number of Meetings Scheduled (Required)

Number of Board meetings scheduled in the past year.

Trustee Name 1 (President/Chair) (Required)

President/Chair

Trustee Address 1 (Required)

Mailing address

City of Trustee 1 (Required)

City in which the trustee resides

Zip Code of Trustee 1 (Required)

Zip Code of the city in which Trustee 1 resides

Term Expires, Trustee 1 (Required)

Mo/Day/Yr

Workshops Attended, Trustee 1

No. of Professional Conferences/Workshops Attended

E-mail Address of Trustee 1

Notes, Trustee 1

Name of trustee this person replaces, if applicable.

Trustee Name 2 (Required)

Trustee Address 2 (Required)

Mailing address

City of Trustee 2 (Required)

City in which the trustee resides

Zip Code of Trustee 2 (Required)

Zip Code of the city in which Trustee 2 resides

Term Expires, Trustee 2 (Required)

Mo/Day/Yr

Workshops Attended, Trustee 2

No. of Professional Conferences/Workshops Attended

E-mail Address of Trustee 2

Notes, Trustee 2

Name of trustee this person replaces, if applicable.

Trustee Name 3 (Required)

Trustee Address 3 (Required)

Mailing address

City of Trustee 3 (Required)

City in which the trustee resides

Zip Code of Trustee 3 (Required)

Zip Code of the city in which Trustee 3 resides

Term Expires, Trustee 3 (Required)

Mo/Day/Yr

Workshops Attended, Trustee 3

No. of Professional Conferences/Workshops Attended

E-mail Address of Trustee 3

Notes, Trustee 3

Name of trustee this person replaces, if applicable.

Trustee Name 4 (Required)

Trustee Address 4 (Required)

Mailing address

City of Trustee 4 (Required)

City in which the trustee resides

Zip Code of Trustee 4 (Required)

Zip Code of the city in which Trustee 4 resides

Term Expires, Trustee 4 (Required)

Mo/Day/Yr

Workshops Attended, Trustee 4

No. of Professional Conferences/Workshops Attended

E-mail Address of Trustee 4

Notes, Trustee 4

Name of trustee this person replaces, if applicable.

Trustee Name 5 (Required)

Trustee Address 5 (Required)

Mailing address

City of Trustee 5 (Required)

City in which the trustee resides

Zip Code of Trustee 5 (Required)

Zip Code of the city in which Trustee 5 resides

Term Expires, Trustee 5 (Required)

Mo/Day/Yr

Workshops Attended, Trustee 5

No. of Professional Conferences/Workshops Attended

E-mail Address of Trustee 5

Notes, Trustee 5

Name of trustee this person replaces, if applicable.

Date (Required)

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Your e-mail address (Required)