Application First Name * Last Name * Nickname or Preferred Name Email Address * This will be your login user name Password * Please enter a password (up to 10 characters). Confirm Password * Confirm Password Birth Date This will not display in your directory profile. Spouse/Partner Name (optional) Name of Sponsor (if you have one) Contact Information Local Street Address Local City Local State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Local Zip Code Preferred Phone Number Alternate Phone Number Is Florida your legal residence? Yes No Alternate Contact Information If you have an alternate address, please check the box below. I have an alternate address Alternate Street Address Alternate City Alternate State/Province AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NH NJ NL NM NS NT NU NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT Alternate Postal Code Alternate Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Which is your preferred MAILING address? Local Address Alternate Address About You Which statement best describes you? I live in the Naples area full time (more than 10 months) I live in the Naples area 1-6 months a year I live in the Naples area 7-10 months a year What is your current employment status? I am retired I am working full-time I am working part-time Please let us know your hobbies and interests. Select all that apply. Hobbies and Interests Bridge, Cards Computers Cooking Crafts Foreign Affairs Gardening Golf Mah Jongg Painting/ Drawing/Visual Arts Photography Politics Reading Running Tennis Travel Walking Water Sports Writing Yoga OtherOther Education History Please list your three highest degrees from an accredited college or university. College or University Field of Study Degree AA AS BA BS JD MA MBA MD MPA MS MSW PhD Other Other Degree College or University Field of Study Degree AA AS BA BS JD MA MBA MD MPA MS MSW PhD Other Other Degree College or University Field of Study Degree AA AS BA BS JD MA MBA MD MPA MS MSW PhD Other Other Degree Career History Please share the three most recent positions you have held. Company or Organization (most recent) Position Held Company or Organization Position Held Company or Organization Position Held Based on your background or education, which best describe your skills? Select all that apply. Skills Finance Accounting Marketing / Public Relations Education and Training Fundraisings / Development IT, Computers Administrative / Clerical Food Service / Hospitality Project Management Legal Medical / Health Human Resources Nonprofit Management Editorial / Writing Art / Creative Design Interior Design Renovation Management OtherOther Local Nonprofit and Civic Experience What LOCAL organizations are you CURRENTLY involved in and what position do you hold? What LOCAL organizations have you belonged to in the past and what position did you hold? Nonprofit and Civic Experience Outside SWFL What organizations are you CURRENTLY involved in outside SWFL and what position do you hold? What organizations have you belonged to outside SWFL in the past and what position did you hold? Make sure you have completed all the required fields, then click on SUBMIT or UPDATE to save your work and advance to the next screen. If you are human, leave this field blank.
