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APPLiCATIONP FOR IREAPPOWTMEN1T TO CEYi Y <br />ADVISORY BOAR DICOM MIESIOi <br />" ' <br />Reappointment to: t�vtf✓1+�0► ��t�r�t ���`� <br />APPLICANT I\IFOR?%IATIO\T <br />Nainu: 6n'c - Sav Cin- of Rusidence: Elk �4uer <br />Occupation: 5bk%A� Dvs 1, t A to I' <br />Statement of Interest: lrleasc �tata: bricfh ,vhy 4-ou are interested in continuing to sugar on the <br />rd; c� mnti ictn f6r which N,xl in: secl.trt� rt al?lroitltrncttt. n 1\1 <br />1. <br />Relevant Experience: 111c:asc dcScribe k our educational, profess1+,tt.t1. Civic, or communirN <br />part) Cil,;at1011. Which rti:tr br relLI'afzt in SCI'V ng pan this board commission. <br />6v f <br />Attendance: \rL VOW—aware of the irral,{ n-rancr (,f rcgular Meeting? ;rttcndancc: iticluding the tit,lc <br />cotitttzittticnr tnr <,it -ed in pr`p:arirt� for rrteetings, and do you feel t ,;u h;a� c tilt. tithe n tailabIc t„ be <br />at] actin t: par rici. ')t Yes L7 No <br />C:onttt,lnt�' ' ► t�_vvC)iyyfl (', %JVA 10 <br />Conflict of Interest i-� dcffi-m] :f., rite p;srticip.trit'r) in a,tt ACtiVitA, rvCr,tttntlftdcd action, or deci41011 <br />front Nt. loch rhe individu ll ha< (n could 11AN-L ncc l,r,rcntial to I-CCri\-L ],Ctson;fl it bL <br />d1reC1 -,r ittdi)-CCL "-SCC attached "C.ottllre( of Interest" Ordinance) <br />In accordtancc xvith till, dctu-lJutm, do ' "Ll have am Itgal a,r cClttitAb1C aiterC1[ in :ant 1]lt5incss, <br />11(meve1,0r atairld, \%hirh COUld he Cr,tt;trttcd as a conflict ofintere�-t� J Yt'!, �Zr, <br />]f pn idc (lL-taik 1,11;1 scl—at:ate T)"ecL of papC1. <br />t rc:aT7r lrtiftilturc D,atu <br />AIIP%]d'%at!on-s%i 1%i be k.Ly)t on ff4' for one t'iurj afterthAt time, .'i nv%i application n7list he Mcd. <br />OFFICE USE ONLY <br />ComicII Mccting Date: _-- <br />❑ Rc;tppoinred <br />Not ]:eappornrcd <br />