Boards/Commissions Volunteer Form

Name of Board/Commission
Your Name
Date
Address (street, city, state, zip)
Employer/Occupation
Home Number
Work Number
Email
Residence within city limits: Yes No
How many Years Here?
Registered Voter: Yes No
Comments on why you would like to be appointed to this board/commission:
Do you engage in business that is anyway related to the duties of this board/commission? Any conflicts of interest?
Are there any days or times you cannot attend meetings on a regular basis?
Is there any information about yourself that you would like to offer the city council to aid them in their appointment process?
References: Please list name, address, phone number of a personal or business reference (providing this information is optional):

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