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September 27, 2010
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I am a member of the Michigan Farmers Market Association
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On my own time
Are you interested in any particular volunteer opportunities or in certain program areas?
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1. I have read the Michigan Farmers Market Association (MIFMA) Volunteer Policy and hereby acknowledge that I understand the volunteer policies of MIFMA.
MIFMA Volunteer Policies
2. I authorize MIFMA to obtain a criminal background check as described in the MIFMA Volunteer Policy.
Yes (if you select this option please proceed on to answer questions 3, 4, 5 and 6.
What is your date of birth?
MM slash DD slash YYYY
3. Please list all names previously used. (i.e. maiden name, married name(s))
4. Please specify your gender.
5. Have you ever been convicted of a felony or criminal offense?
Yes (if yes, please use the box below to explain).
If you answered yes to question number 5 above, please use the box below to explain.
6. Have you resided in a state other than Michigan within the last five years?
Yes (if yes please use the paragraph below to list which states you have lived in).
No, I have only lived in Michigan
If you answered yes to question number 6 above, please use the box below to list all other states you have lived in.