Board & Chapter Contact Information | Virginia Center for Inclusive Communities

VCIC New Board & Chapter Member Contact Information & Preferences

Welcome to the Virginia Center for Inclusive Communities, and thank you for your commitment to serve! VCIC is able to deliver hundreds of programs to over 25,000 participants annually because of the commitment, insight and generosity of leaders like you, and your participation in our work makes a difference every day, all across our Commonwealth. In order to help VCIC staff and Board/Chapter officers keep in touch with you about upcoming meetings and action opportunities, we ask you to take 5 minutes to complete the form below so that we can have your most up-to-date contact information and preferences. This information form also includes some demographic questions; we keep this information private, but need it to use in the aggregate for reporting to funders on Board diversity and for identifying areas of growth for Board and Chapter membership. If you have any questions or trouble with any of the items on this form, please don't hesitate to reach out directly to Jonathan Zur.

Contact Information

Email Address: *

Title (Dr./Ms./Mr./Etc.):

Full Name (exactly as it should be listed on VCIC materials; note that our default style is Mary A. Smith):

Nickname (if any):

Employer (exactly as it should be listed on VCIC materials):

Title/Occupation (exactly as it should be listed on VCIC materials):

Home Mailing Address:

Apt, suite, etc.

Country

City

State

Zip code

Home Phone:

Cell Phone:

Personal Email:

Work Mailing Address (if any):

Apt, suite, etc.

Country

City

State

Zip code

Work Phone (if any):

Work Email (if any):

Do you have an assistant who should be copied on VCIC Board/Chapter communications? If so, please share their name, email, and phone number here:

Contact Preferences

I prefer to receive VCIC mail at my...

I prefer to receive VCIC email at my...

Demographic Information

Please share how you identify in the following areas:

Date of Birth

In terms of race/ethnicity, I identify as...

In terms of gender, I identify as...

In terms of religion, I identify as...

Are there any other identities that you want to share, or that you feel are particularly salient to your work with VCIC? If so, please share that information here:

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