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Attendance: Are your aware of the importance of regular meeting attendance including the time <br />commitment involved in preparing for meetings, and do you feel you have the time available to be <br />an active participant? Of Yes ❑ No <br />Continents: <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 gait, whether it he <br />direct or indirect. (See attached "Conflict of Interest" Ordnance) <br />In accordance with this definition, do you have any legal or equitable interest in any business, <br />however organized, which could he construed as a conflict of interest? ❑ Yes U No <br />If yes, provide details on a se arateip ece of paper. <br />c2dc e- �)Cl r"i�2oen� (2d,yo4zt' 31, zo rs <br />Applicant Signature Date <br />Questions may be directed to the Administration Department at 763.635.1000. <br />OFFICE USE ONLY <br />The Applicant is: ❑ New Applicant I Applying for Reappointment <br />Council meeting date: I I I 1 <br />❑ Appointed to: <br />Term Expires: <br />❑ Not Appointed <br />