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<br />eb 14 OS 11:5Sa <br /> <br />The Jungle Famil~ Hair Sa (73) 241-1580 <br /> <br />p.2 <br /> <br />CIVIC AND COMMUNITY ACTIVITIES: <br /> <br />Describe past or present civic and! or community activities that may be relevant in qualifying you to <br />serve on this board or commission.+:" tv d f PL. )1/}t:/"J7 be~ c7)L' a. 9-1/ /// C-~ <br />Ir-tth'I':-/7/'h2- ?17/cI sUrf/eel tWbtr I tJo I/l)/ V'/?-Icrer- hav/r J <br />pbl--1.r'Nr...!ftI'y Lt-fje'a rg.. / tUC2J at"ftJ Ofn e/7~p/t7L(e..e <br />C;:~~;fu~: -fy -rvr h'7c{/n it tyee! rs . {f'ecrea.-h c~ iJL-p~) <br /> <br />Are you aware of the importance of regular meeting attendance including the time commitment <br />involved in preparing for meetings. and do you feel you have the time available to be an active <br />participant: X Yes _ No <br /> <br />Comments: <br /> <br />CONFl..ICT OF INTEREST: <br /> <br />I wish to disclose the following potential conflicts of interest that mayor will arise if I become a <br />member of this board or commission. (See attached "Conflict of Interest" Ordinance) <br /> <br />rpt <br /> <br />~.~~1h4/tAZ-, <br /> <br />Signature <br /> <br />2--13-0 t <br /> <br />Date <br /> <br />--------------------------------------------------------------------------------------------------------- <br /> <br />The selection process will vary according to 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 />Return Application To: <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 />Dare Appointed: <br /> <br />Term Length: <br /> <br />:-:.:... ~: <br /> <br />-...:'~:I.:I.:n;1 "'H.' '_~''-'. '~~'1.; j,:~~,.--.. :"~~";";";"l,'~ ':'-:;:-':'~':. ,.': <br /> <br />Phone: 763.635-1000 <br />Fax: 763.635-1090 <br />W'WW.ci.elk-rivcr .mn.LJS <br />