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City f� APPLICATION FOR REAPPOINTMENT TO CITY E1 ^-'` ADVISORY BOARD/COMMISSION River 13,161[1.......14u 6 w Commission Reapplying for Library Board First Name Last Name Mary Keifenheim Address T City Elk River State MN ip 55330 Home Phone Cell Phone Email Employer Retired Occupation Public Contact Information The city maintains a directory of current board/commission members on the city's website. Once appointed, state statute requires members to provide a telephone number, email address, or both where the applicant can be reached. This is the contact information we will include in our online directory. Please indicate which contact information you would like us to use: ❑ Home Phone Number ❑ Cell Phone Number di Email Address State briefly why you are interested in continuing to serve on the board/commission for which you are seeking reappointment: I would like to serve on the Library Board for another term because I am interested in modifying and perhaps expanding the board's role. The library is a wonderful community asset and hopefully, the board could play a role in increasing community support and involvement. Attendance Are you aware of the importance of regular meeting attendance including the time commitment involved in preparing for meetings, and do you feel you still have the time available to be an active participant? It Yes ❑ No Conflict of Interest is defined as the participation in any activity,recommended action, or decision from which the individual has or could have the potential to receive personal gain,whether it be direct or indirect. Do you have any legal or equitable interest in any business,however organized,which could be construed as a conflict of interest? ❑ Yes M No If yes, explain on a separate sheet of paper. ISI i-�- /� 19 Applicant Si tore Date Board/Commission Application Page 1 of 1