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11/18/10 09:44 FA% 763 441 2827 Al1E GROliP 0 003 <br />Attendance: Axe your aware of the importance of regular meeting attendance includuig the tune <br />cormxtiunent invoh*ed in preparing fox meetings, and do you feet }you have the tune available to be <br />an active participant? ,~ Yes ^ No <br />Continents: <br />Conflict of Interest is defined as the participation ux any activity, recommended action, ox decision <br />from which the individual has ox could have the potential to receive personal gain, whether it he <br />direct ox indirect. (See attached "Conflict of Interest" Ordinance) <br />In accordance with this definition, do you have any Icgal ox equitable interest in an ~ business, <br />however organized, which could be construed as a conflict of interest? ^ Yes ~No <br />If ye/s, provide details on a sc orate iece of a er. <br />Appli~ant Signature C Date <br />Questions may be directed to the Administration Depaxtrncnt at 763.635.1000. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />^ New Applicant <br />^ Not Appoutted <br />^ Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />Applying fox Reappointment <br />