Richard Jay Simon Artistic Director	BOARD OF DIRECTORS APPLICATION   1. Contact Information Name Address City/State/Zip Telephone E-mail     2. Experience      Do you have experience serving on other boards? Yes No      If yes, what other boards do you currently serve on?      If you do have experience on a board, what committees have you      participated in?      Have you participated in any other board activities besides      board meetings? Yes No      If yes, what? 3. Commitment      The Mosaic Theatre Board meets nine times a year for approximately 90      minutes.  Each Mosaic Theatre board member is also required to serve on a      committee and make an annual donation to the theater.  Are you able to      commit this amount of time to meetings, contribute personally to the nonprofit      organization, and to commit to the other work necessary in governing this      organization? Yes No      If yes, Which committee do you feel you could best serve?      Finance Board Development and Nominating PR and Marketing Select Committee Programs and Events Fundraising and Development 4. Special Skills or Qualifications      Summarize special skills and qualifications you have acquired from      employment, previous volunteer work, or through other activities, including      hobbies or sports.  Please email your resume to rsimon@mosaictheatre.com      5. Agreement and Signature      By submitting this application, I affirm that the facts set forth in it are true and      complete.  I understand that if I am accepted as a Board Member of Mosaic      Theatre, any false statements, omissions, or other misrepresentations made      by me on this application may result in immediate dismissal.      Signature           Date               6. Our Policy      It is the policy of this organization to provide equal opportunities without      regard to race, color, religion, national origin, gender, sexual preference, age,      or disability.      Thank you for completing this application form and for your interest in serving      on the Mosaic Theatre Board of Directors.  MAIL TO MOSAIC THEATRE, 12200 West Broward Blvd., Plantation, FL 33325 PHONE (954) 57-STAGE (78243)        FAX (954) 473-4713
	American Heritage Center for the Arts, 12200 West Broward Boulevard, Building 3000 Plantation, Florida 33325,  phone: (954) 577-8243