YPN Leadership Council Application

This is the form for the YPN Leadership Council. The form for general membership or renewal can be found at bemidji.org/ypn.

First Name *

Last Name *

Date *

Format: MM/dd/yyyy

Name of Business/Organization *

Business/Organization Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Mobile Phone Number *

Email *

How long have you lived/worked in the Bemidji area? *

Are you applying as a representative of your business/organization or an individual? *

Representative of Business/Organization Individual

The YPN Leadership Council meets at noon on the second Wednesday of each month. Do you foresee any conflicts in attending these meetings? *

Yes No

If yes, please explain:

Does your employer endorse your position as a member of the YPN Leadership Council? *

Yes No

List up to three organizations in which you have been, or are currently active in, and any leadership positions held. Please includes dates and leadership responsibilities: *

Tell us about any interests, skills or hobbies: *

Why are you interested in joining the YPN Leadership Council? *

YPN Leadership Council Application

Your Connection. Your Voice. Your Success.