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<br />SEP-29-2004 (WED) 10:03 <br /> <br />HANSON SPANCRETE MIDWEST <br /> <br />(FAX)7634251277 <br /> <br />P. 003/003 <br /> <br />r:rvrr: AND r:OMMUNITY Ar:TTVTTT'F.S: <br /> <br />Describe past or present civic and/or communitpctivitics that may be relevant in qu:ilifyingyou to <br />serve 00 this board 0< commission. <br />- tJ.T\opoJ~ t-J'I..ttT CUI <br /> <br />A1'JF.NDANl.':K= <br /> <br />Ne you aware of the impOtt:LaCC of regubr meeting attendance including d,e time committncnt <br />involved in prcpD<ing for meedngs, and do you fed you have the time avail.~ble to b. an active <br />participant: ~ Yes _No <br /> <br />CommCl1tS: <br /> <br />CONFT.Tr:T OF TNTEREST: <br /> <br />I wish to disclose the following potenti:Ll con:flicts of in=cst that m.~y or wiU arise if I become a <br />member ofd,is board or commission. (See att::lched "Cower of Ittrcresr" Ordiaaaee) <br /> <br /> <br /> <br />~~ <br /> <br />Date <br /> <br />51 <br /> <br />The s criOD process Will vory cording [() the number of applicantS and vacancies, and may not <br />include interviews with all candidates. <br /> <br />THANK YOU FOR YOUR INTEREST IN SERVING ON A BOARD OR COMMISSION. <br /> <br />R~m~ ^np]j~rinn Tn: <br /> <br />OFFICE USE <br /> <br />City of Elk River <br />City Clerk's Office <br />13065 Orono Parkway <br />Elk. River, MN 55330 <br /> <br />Appointed To: <br /> <br />Da.. Appointed: <br />Tcan Lcngdt: <br /> <br />Phone: 7tS3.1i35-1000 <br />r-... 763,6.5-'090 <br />WVIII.ci.CJk-dvcr.mtMD <br /> <br />S~dcrklb.rdcum./QPp1JClldDnl "PpUcatlon <br />