BOARD APPLICATION Board Member Interest FormFillable PDF Version Name * Mailing Address * How long have you been an FMIC Policyholder? * Phone * (###) ### #### Email * Occupation Were you referred by a current or former Board or staff member? Please enter the person's name here. Why are you interested in serving on the FMIC Board of Directors? What special contributions would you make as a Board member? Professional/Business/Volunteer affiliations: Membership in other organizations. Skillset The FMIC Board would like to know what skills you would contribute as a Board candidate. Please check the following that would apply: Insurance Business Development Marketing Contracts Investments Law Other Applicant's Signature * Date * MM DD YYYY Thank you for your submission. A member of our staff should reach out to you shortly. You can always email us at:Family@familymutualinsurance.com
