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MEET THE HLN EXECUTIVE COMMITTEE
ALI MANDELL KALI WICKS BETH BROWN ALANA CUNNINGHAM
HLN BOARD REP. HLN CO-CHAIR HLN CO-CHAIR HLN TREASURER/STAFF LIASON
Application
NAME: ________________________________________________________________________________________ ADDRESS: ________________________________________ CITY _________________ , MT ZIP: ___________ BEST PHONE NUMBER: ___________________________ E-MAIL:___________________________________ BUSINESS WHERE EMPLOYED: ______________________________________________________________ AMOUNT PAID $ _____________________________ (CASH, CHECK, OR CREDIT CARD ACCEPTED) IF CREDIT: CARD NUMBER_______________________________________ EXP. DATE:_______________
MAIL THIS FORM AND PAYMENT TO:
HELENA LEADERS NETWORK 225 N. CRUSE AVE. , STE A HELENA, MT 59601
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