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t��v ar <br />Elk — <br />F�iver <br />31Wi5 ()rn,rn Park..�v <br />7G3.635.1 WO <br />APPLICATION FOR REAPPOINTMENT TO CITY <br />ADVISORY BOARD/COMMISSION <br />Commission Reapplying for <br />hi �-rI-�q; rP-Ser-uc,4 0 <br />First Name <br />Last Name <br />-P6r0,� <br />C)r- +e,-)sC,-\- <br />Address <br />City <br />State <br />Zip <br />eon <br />), i <br />_ <br />5330 <br />Home Phone <br />Cell Phone Email <br />w/A <br />Employer <br />Occupation ' <br />Public Contact Information <br />The city maintains a directory of current board/commission members on the city's website. Once <br />appointed, state statute requires members to provide a telephone number, email address, or both where <br />the applicant can be reached. This is the contact information we will include in our online directory. <br />Please indicate which contact information you would like us to use: <br />❑ Home Phone Number ® Cell Phone Number ® Email Address <br />State briefly why you are interested in continuing to serve on the board/commission for which you are <br />seeking reappointment: �- ee. ) S +r-v n f I� q 4 L J ,4,>, a <br />,—d e ro -)-no f-c o v(�►>'d�`o^A <br />U)"s 1�-VorS <br />Attendance <br />Are you aware of the importance of regular meeting attendance including the time commitment involved <br />in preparing for meetings, and do you feel you still have the time available to be an active participant? <br />® Yes ❑ No <br />Conflict of Interest is defined as the participation in any activity, recommended action, or decision from <br />which the individual has or could have the potential to receive personal gain, whether it be direct or <br />indirect. Do you have any legal or equitable interest in any business, however organized, which could be <br />construed as a conflict of interest? ❑ Yes 91 No <br />If yes, explain on a separate sheet of paper. <br />Applicant Signature <br />Date <br />Board/Commission Application <br />Page 1 of 1 <br />