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2. Name of Board/Commission
   Please note that preference will be given to forms that are completely filled out. Forms missing information may be disqualified per City Council's discretion. Please answer n/a if not applicable.
4. Your Name
6. Date
8. Address1
10. Address2
12. City
13. State
14. Zip
16. Employer/Occupation
18. Home Number
20. Cell Number
22. Email
24. Residence within city limits:
    (Yes or No)
26. If yes, how many years?
28. Registered Voter:
    (Yes or No)
30. Comments on why you would like to be appointed to this board/commission:
32. Do you engage in business that is anyway related to the duties of this board/commission? Any conflicts of interest?
34. Are there any days or times you cannot attend meetings on a regular basis?
36. Is there any information about yourself that you would like to offer the city council to aid them in their appointment process?

    Please note that preference will be given to forms that are completely filled out. Forms missing information may be disqualified per City Council's discretion. Please answer n/a if not applicable.

38. References: Please list name, address, phone number of a personal or business reference:

    Please note that preference will be given to forms that are completely filled out. Forms missing information may be disqualified per City Council's discretion. Please answer n/a if not applicable.

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40. 1. Receive an email copy of this form.
41. Email address

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42. Submit

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