CITIZEN PARTICIPATION APPLICATION

I am interested in serving on:
	Board of Commissioners Board of Adjustment Planning and Zoning Board Historic District Commission Parks and Recreation Board Flood Management Appeal Board
Please provide the following contact information:
Name
Address
City
State
Zip
Phone
Email
Years of Residence:
Present Employer and Job Title:

Age:
Currrent Civic/Community Participation:

Please provide any pertinent information that qualifies you for service on this Board, Commission, or Committee:

Education:
If appointed, when could you meet:
	AM Afternoons PM
If any, what Board, Commission or Committees are you presently serving on:

Do you anticipate any conflicts of interest if appointed, if yes, please explain:

Please note: Applications will be kept on file for one year. After one year applicants, must resubmit an application.