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2. First Name*
3. Last Name*
4. Date:*
   Date:
6. Address*
8. City*
9. State*
10. Zip Code*
12. Home Phone*
13. Cell Phone*
15. Email Address*
16. Length of Residency (in years)*
18. Business Name
19. Business Address
23. Committees of Interest:*

    1. Cultural Inclusion and Diversity Committee
    2. Environmental Committee
    3. Sister Cities Committee
    4. Veterans Committee

    1. Development Commission
    2. Historical Commission
    3. Special Events Committee
27. EDUCATION
    Beyond high school; include specific degrees or vocational training; year degree awarded; major; institution name, city & state.
29. Employment Resume
    Please attach
33. COMMUNITY PARTICIPATION
    Past/Present
37. SPECIAL QUALIFICATIONS FOR SERVICE:
41. WHY DO YOU DESIRE THIS APPOINTMENT?
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43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

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