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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: ~ re s !A ~a /~ <br />/nc:.~/Ccc.r'~s" v~ ~'evei~l t'. 2. a/epcs~~/•--rn~ /~s~nC~/' ~.,ear~: <br />fig _~ •~ e•+:. ` a r/C c~ H !Ants'! ~''~!"~n n.rYir w~"' ~ ~.- <br />/~.~ a o!c/f ~z- c2C~i'v~t./`/ f!a•i fr ~~c/ f ~. C.2 ~ G'4~ /h l~,~YF,i'hl' <br />Conflict of Interest is defined as the participation in any activity, reconunended 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 />.~ •Us` •i;o/a <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: ^ New Applicant ^ Applying for Reappointment <br />Council Action: <br />^ Not Appointed <br />^ Appointed to: _ <br />Date Appointed: <br />Term Expires: _ <br />