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2016-01-06 P & R Packet
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2016-01-06 P & R Packet
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12/16/2015 7:56:21 AM
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tIr CITY OF CENTERVILLE <br /> APPLICATION FOR APPOINTMENT <br /> Committee or Commission applying for: <br /> NAME: <br /> STREET ADDRESS: <br /> CITY: , MN ZIP CODE: <br /> HOME TELEPHONE: WORK TELEPHONE: <br /> FAX: EMAIL ADDRESS: <br /> Number of years a Centerville Resident?: <br /> Are you presently serving on a Centerville Committee or Commission?: <br /> Which One?: Term?: <br /> Have you served on a Centerville Committee or Commission in the past?: <br /> Which One?: Term?: <br /> Which One?: Term?: <br /> What do you have to offer the City of Centerville as a Committee or Commission <br /> member?: <br /> Experience or Education that would enhance your effectiveness as a Committee or <br /> Commission member?: <br /> Signature: Date: <br /> Return to: City Administrator <br /> City of Centerville <br /> 1880 Main Street <br /> Centerville, MN 55038 <br />
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