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Attendance: Are your aware of the importance of regular meeting attendance including the time <br />commitment involved in preparing for meetings, and do you feel you have the time available to be <br />an active participant? ,,Yes ^ No <br />Comments: -~- ~-P <br />I:M,e~'c~i~ ~ <br />~ Q `~i._ <br />(S (~ ~-- <br />~.,~,(tLL"J ~ c~C <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 se arate iece of a er. <br />~.~~~4~ <br />Applicant 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 /> <br />~~~ ~ <br />Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />Applying fox Reappointment <br />