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<br />~ <br />~HILLS <br /> <br />City Committee Application Form <br /> <br />Date );;1 - 3 - C!:> c" <br /> <br />General Information <br /> <br />Address <br />City, State, ZIP <br /> <br />Phone Numbers <br /> <br />;loleU/A <br />Last <br />L(~ PO <br /> <br />A/V~~ <br /> <br />0. <br />MJ. <br /> <br />Name <br /> <br />First <br />/ I e.4 :;,,4;t/T <br /> <br />J//t/&Y€ <br /> <br />5'5//~ <br /> <br />Email Address <br /> <br />Home 0$" I - 6 ~ 3 - G s,.:7 ( Work <br />Fax Fax <br />~7J..o le......-:7 @ e4.L7t_/.//7/k. <br /> <br />Nee- <br /> <br />Committees <br />If you wish to be considered for more than one committee, please order in number of preference. <br /> <br />Communications Committee (Newsletter) <br />Parks, Trails, & Recreation (PTRC) <br />Economic Development Commission <br />.......--planning Commission <br /> <br />Special Interests <br />As the Council prioritizes its goals, it may create additional/new committees or task forces from time to time. Ifyau <br />have other specific areas or topics of interest please indicate those interests and we will retain your application for <br />future openings in those areas as new committees are created. <br /> <br />Other Interests 1S:V,/'rA/e-r'_ <br /> <br />$5e75#~...p/7 <br />, <br /> <br />Personal Information <br /> <br />List your work experience. <br /> <br />C~74o/ V~U <br />Zn/7€ //i'JL <br />L ,,:-v: 'e,d: ~ <br /> <br />A..-~4~~<(' - SoJ'-Za//iZ-<.. -p <br /> <br />City Committee Application Fonn <br /> <br />Page I of2 <br />