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Attendance: Are your aware of the importance of regular meeting attendance including the time <br />commitment involved preparing for meetings, and do you feel you have the time available to be <br />an active participant? f Yes ❑ No <br />SLi MAIe .. ._y <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 any business, <br />however organized, which could be construed as a conflict of interest? ❑ Yes No <br />If yes, provide details on a separate pkce of 12al2er. <br />Z4441'&M% WV///,/, <br />Apphcant Signature Date <br />Questions may be directed to the Administration Department at 763.635.1000. <br />OFFICE USE ONLY <br />The Applicant is: <br />Council Action: <br />New Applicant <br />❑ Not Appointed <br />Ll <br />Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />❑ Applying for Reappointment <br />