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2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneBoard of AdjustmentBoard of AppealsCivil Service CommissionCommunity Redevelopment AuthorityLibrary BoardPlanning Commission
4. Personal Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number*
19. Occupation*

    (If retired, please indicate former occupation or profession.)

21. Email Address*
23. Education
25. High School
27. College
29. Trade or Business School
31. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
33. If yes, which
35. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
37. If yes, which
39. Professional and/or Community Activities

    Please list any organization memberships and positions held

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41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

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