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Attendance:Are your aware of the importance of regular meeting attendance including the time <br /> commitment involvedpreparing for meetings,and do you feel you have the time available to be <br /> an active participant? Yes ❑ No <br /> Comments: <br /> II <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 an business, <br /> howev- .rganized,which could be construed as a conflict of interest? ❑Yes ' No <br /> If yes pro *de details on a separate piece of paper. <br /> / t- <br /> Ap)licant Si.�yly�e Date <br /> Questions may be directed to the Administration Department at 763.635.1000. <br /> This application will be kept on file for one year; after that time a new application <br /> must be filed. <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant ❑ Applying for Reappointment <br /> 1 Council Action: ❑ Not Appointed <br /> ❑ Appointed to: <br /> Date Appointed: <br /> Term Expires: <br /> ��II <br />