NOMINATING PROFILE       

Please complete this profile and mail it to: KCI Partners, Attn: Nikki London, Barbara Ann Karmanos Cancer Institute, 3031 W. Grand Blvd. Detroit, MI 48202 (or fax to: 313-576-8220).Once your profile is received, a member of the Partners Executive Committee will call you to arrange a time to meet. Should you have questions prior to this meeting, please feel welcome to call Nikki London in the Development Office at (313) 576-8107.

Name:  ____________________________________________________________________________

Address:  __________________________________________________________________________

__________________________________________________ Email: __________________________

Home Phone: ________________ Work Phone: __________________ Fax: __________________

Date of Birth: _______________________Spouse’s Name:_________________________________

Children/Family:   __________________________________________________________________

Education:  ________________________________________________________________________

___________________________________________________________________________________

Employer: _________________________________________________________________________

On a separate sheet of paper, please type your responses to the following questions:

1. Please describe any previous involvement with the (formerly MCF) Partners and/or the Barbara 

     Ann Karmanos Cancer Institute.

2. Are you active in other charitable organizations?  If so, please describe your involvement.

3. Why would you like to serve on the Karmanos Cancer Institute’s Partners Executive Committee? 

     What do you hope to gain from this experience? 

4. What questions do you have about the Karmanos Cancer Institute’s Partners and/or the Barbara

     Ann Karmanos Cancer Institute?

    Thank you for your interest in the Karmanos Cancer Institute’s Partners Executive Committee. 

                                                       We will be contacting you in the near future.