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  <div id="header"> <img src="images/meflogo2.jpg" width="285" height="160" />

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    <p><b>Welcome to the Marin Economic Forum application process!</b><br>
      In 2010 all Directors and Associates have a one year term, so all Directors and Associates need to reapply for 2011 and beyond. In 2011, about 1/3 each of the Directors will be assigned a one-, two-, or three-year term based on their contributions to dates. Thereafter, all Director terms will be for three years. Associate positions are renewable annually. <br />
</p>
    <p><b>As you enter information in each field on this screen, please first read the detailed instructions at the bottom of the screen.</b><br />
      Please note that applicants elected to Director will be expected to help raise funds to support the Forum, attend quarterly board meetings, participate on at least one working committee and provide leadership on key issues. <br /><br />

<form name="application" method="post" action="send_form_application.php">
Name [Last, First MI] <input type="text" name="name" /><br />
Primary Organization <input type="text" name="primary_organization" /><br />
Primary Position <input type="text" name="primary_position" /><br />
Street Address <input type="text" name="street" /><br />
City <input type="text" name="city" /><br />
State <input type="text" name="state" /><br />
Zip Code <input type="text" name="zip" /><br />
Email Address <input type="text" name="address" /><br />
Daytime Phone <input type="text" name="day_phone" /><br />
Mobile Phone <input type="text" name="mobil_phone" /><br />
For Profit based? <input type="checkbox" name="qualify1" value="profit" /> Check if your experience and perspective are primarly from the for-profit business community in Marin County<br />
Marin Work Place? <input type="checkbox" name="qualify2" value="workplace" /> Check if your primary work place is in Mairn<br />
Marin Resident? <input type="checkbox" name="qualify" value="resident" /> Check if you reside in Mairn<br />
<p>
QUALIFICATIONS [Please summarize all your MEF-relevant experience (including your primary organization) indicating organizations/groups iwth whom you have worked and in what capacity.]
<p><br />
    <span class="style2">Organization or Group</span>
    <span class="style2">
  <input type="text" name="group1" />
    </span>
  Position(s)/Tenure
  <input type="text" name="position1" />
  <br />
    <span class="style1">Organization or Group</span>
    <input type="text" name="group2" />
    <span class="style1">Position(s)/Tenure
  <input type="text" name="position2" />
  <br />
    Organization or Group</span>
    <span class="style1">
  <input type="text" name="group3" />
    Position(s)/Tenure
<input type="text" name="position3" />
  <br />
    Organization or Group</span>
    <span class="style1">
  <input type="text" name="group4" />
    Position(s)/Tenure </span>
    <input type="text" name="position4" />
  <br />
    <span class="style1">Organization or Group</span>

    <input type="text" name="group5" />
    <span class="style1">Position(s)/Tenure</span>
    <input type="text" name="position5" />
  <br />
<p>
2010 ACCOMPLISHMENTS
<p><br />
  Status during 2010
  <SELECT NAME="position">
    <OPTION VALUE="1"> Director
      <OPTION VALUE="2"> Associate
    </SELECT>
<p><br />
   <span class="style2">Comittees Served On</span>
    <span class="style2">
  <input type="text" name="comittee1" />
    </span>Position on each Comittee
  <input type="text" name="comittee_position1" />
  <br />
    <span class="style1">Comittees Served On</span>
    <input type="text" name="comitee2" />
    <span class="style1">Position on each Comittee
  <input type="text" name="comittee_position2" />
  <br />
    Comittees Served On</span>
    <span class="style1">
  <input type="text" name="comittee3" />
    Position on each Comittee
<input type="text" name="comittee_position3" />
  <br />
    Comittees Served On</span><span class="style1">
    <input type="text" name="comittee4" />
    Position on each Comittee </span>
    <input type="text" name="comittee_position4" />
  <br />
    <span class="style1">Organization or Grou</span>

    <input type="text" name="comittee5" />
    <span class="style1"> Position on each Comisss.</span>
     <input type="text" name="comittee_position5" />
  <br />
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  <td width="191">Accomplishments in 2010. Please give a brief description</td>
  <td width="785">

<textarea rows="10" cols="80" name="accomplishments"></textarea>
</td>
</tr>
</table><p>
2010 GOALS AND INTERESTS<br />

<table>
  <tr>
  <td width="191">Interests/Goals 2011. Please give a brief description</td>
  <td width="785">
<textarea rows="10" cols="80" name="interests"></textarea>
</td>
</tr>
</table><p>
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  <td width="191">Additional Comments</td>
  <td width="785">

<textarea rows="10" cols="80" name="comments"></textarea>
</td>
</tr>
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<input type="submit" value="Submit">

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