*Library name

*Director

*Library email address

*Are all board positions filled? Yes No

*If not, how many positions are unfilled?

Please list the names of the trustees' who will be, and are serving on the board for the year 2009. Provide complete home mailing addresses for each trustee (board member). Please complete the President, Vice-President, Secretary, and Treasurer members, followed by the rest of the trustees. If the system representative is also a board member, please list the information here as well. Systems use this information to correspond with trustees so it is important to have the correct information listed.

*President's name

*President's home address

*President's city *President's zip code

*President's phone including area code

President's email address

(Explain board position and dates of term)

President's dates of term

(Explain first and second terms)

Is this President/trustee serving First full term Second full term

(Explains if trustee is filling a term for another board member)

Is this President/trustee filling an unexpired term for another board member? Yes No

If yes, who did the President/trustee replace?

*Vice President's name

*Vice President's home address

*Vice President's city *Vice President's zip code

*Vice President's phone including area code

Vice President's email address

Vice President's dates of term

Is this Vice President/trustee serving First full term Second full term

Is this Vice President/trustee filling an unexpired term for another board member? Yes No

If yes, who did the Vice President/trustee replace?

*Secretary's name

*Secretary's home address

*Secretary's city *Secretary's zip code

*Secretary's phone including area code

Secretary's email address

Secretary's dates of term

Is this Secretary/trustee serving First full term Second full term

Is this Secretary/trustee filling an unexpired term for another board member? Yes No

If yes, who did the Secretary/trustee replace?

*Treasurer's name

*Treasurer's home address

*Treasurer's city *Treasurer's zip code

*Treasurer's phone including area code

Treasurer's email address

Treasurer's dates of term

Is this Treasurer/trustee serving First full term Second full term

Is this Treasurer/trustee filling an unexpired term for another board member? Yes No

If yes, who did the Treasurer/trustee replace?

*Trustee 1 name

*Trustee 1 home address

*Trustee 1 city *Trustee 1 zip code

*Trustee 1 phone including area code

Trustee 1 email address

Trustee 1 dates of term

Is this trustee 1 serving First full term Second full term

Is this trustee 1 filling an unexpired term for another board member? Yes No

If yes, who did the trustee 1 replace?

*Trustee 2 name

*Trustee 2 home address

*Trustee 2 city *Trustee 2 zip code

*Trustee 2 phone including area code

Trustee 2 email address

Trustee 2 dates of term

Is this trustee 2 serving First full term Second full term

Is this trustee 2 filling an unexpired term for another board member? Yes No

If yes, who did the trustee 2 replace?

*Trustee 3 name

*Trustee 3 home address

*Trustee 3 city *Trustee 3 zip code

*Trustee 3 phone including area code

Trustee 3 email address

Trustee 3 dates of term

Is this trustee 3 serving First full term Second full term

Is this trustee 3 filling an unexpected term for another board member? Yes No

If yes, who did the trustee 3 replace?

Explain what the System Representative is

Who is the designated system representative for the library's regional system? This is usually the director but may be a board member.

*System Representative's name

System Representative's home address

System Representative's city System Representative's zip code

System Representative's phone including area code

System Representative's email address

System Representative's position

System Representative's term

Additional comments