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APPLICATION <br /> City of <br /> ADVISORY BOARD/COMMISSION <br /> hl <br /> RiVReappointment to: <br /> 13065-6rono Parkway ( <br /> 763.635,1000 <br /> APPLICANT INFORMATION G � F <br /> Name: City of Residence: <br /> Occupation: 1_ Employer: 6 1 C-, <br /> ( <br /> Statement of Interest: Please state briefly why you are interested in continuing to serve on the <br /> board/commission or w 'ch o are seeking reappointme t. <br /> W, kuv <br /> k�- P PLVI— °er z, 6 c <br /> Relevant Experience: Please describe your educational,professional, civic, or community <br /> participation,which may be relevant in serving on this board/cq ss�(?n. <br /> L 4N <br /> G <br /> Attendance:Are your aware of the importance of regular.meeting attendance including the time <br /> commitment involve. preparing for meetings, and do you feel you have the time available to be <br /> an active participant?AYes 0 No <br /> Comments: <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 i a y business, <br /> however organized,which could be construed as a conflict of interest? El Yes No <br /> If yes,Ito ece of pam. r. <br /> �l <br /> ) <br /> 1� <br /> Applicant Signature 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 /> Ll Not Reappointed <br />