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APPLICATION FOR REAPPOINTMENT TO CITY <br /> City of ADVISORY BOARD/COMMISSION <br /> Elk - - <br /> River Reappointment to: !-( 7 &Yi4 <br /> 13065 1000 Parkway j 763.6355 1000 <br /> APPLICANT INFORMATION <br /> Name: i 1UE i-71I City of Residence: %le=1 <br /> Occupation: Di ad-or- ruU'l (itier Employer: :11-1,4 `'� / t /i C 4- <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> Y YY g <br /> board/commission for which you are seeking reappointment. <br /> . 4_ h cL, 01 0I tAeco <br /> sdiu- et/►mrn <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/commission. <br /> /- '& U -- �► 2 e � L Gt —+�/r /t r.eyy ma frit ( g - <br /> JiWQ g- v'v1u. cd`-et.ar, (-fieSek(11 L e�� n' -��c (11.it. <br /> - <br /> a/n torev ark „-7f & (J t,c ,0,��n �/ a 6Lt.. <br /> Attendance:Are your aware of the importance of regular meeting attendance including the time <br /> commitment involved in ireparing for meetings,and do you feel you have the time available to be <br /> an active participant? to Yes ❑ No <br /> Comments: .rf hwU /k& /11.0-34 O /107Y ..0.,04-7t t'7 • <br /> Conflict of Interest is defined as the participation in any activity,recommended action, or decision <br /> from which the individual has or could have the potential to receive personal gain,whether it be <br /> direct or indirect. (See attached"Conflict of Interest" Ordinance) <br /> In accordance with this definition, do you have any legal or equitable interest in any business, <br /> however organized,which could be construed as a conflict of interest? ❑ Yes No <br /> If yes,provide details on a separate piece of paper. <br /> (Att i/ 214?_ <br /> Applicant Signattir Date <br /> Applications will be kept on file for one year;after that time, a new application must be filed. <br /> OFFICE USE ONLY <br /> Council Meeting Date: <br /> ❑ Reappointed <br /> Term Expires: <br /> ❑ Not Reappointed <br />