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<br /> <br />P.O. Box 8181 * Hillsborough, North Carolina 27278 <br />Telephone: 919 245-2626 <br />Applicant Organization & Collaborator Information <br /> <br />Please provide the following information about the primary applicant organization: <br /> <br />Contact Information for Primary Contact, Chief Executive Officer / Executive Director, and Chief Financial <br />Officer <br />Primary Contact <br />Name J. Jay Kennett <br />Title Pastor <br />Preferred phone number 336.213.7831 <br />Email address jaykennett@hucc.org <br />Fax number (if applicable) na <br /> <br />Chief Executive Officer / Executive <br />Director <br />Name Russell Knop <br />Title Trustee Chair <br />Preferred phone number 919-612-8019 <br />Email address russell.knop@gmail.com <br />Fax number (if applicable) <br /> <br />Chief Financial Officer <br />Name Jeff McQueen <br />Title Treasurer <br />Preferred phone number 919-259-3860 <br />Email address jeff_mcqueen@med.unc.edu <br />Fax number (if applicable) <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: 1DA01EE2-D61E-4F21-8905-BE343438D3ED