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Sep. 4. 2007 11:26RN COMMUNITY NEAjTH Na~0822 P. 5 VJltnt is your view of the role of fhis ComnrissionlComnuttee/Task Force? Tenuessen Warning -Some or all the information Ihe[ you are asked to provide is classi5cd 6y State law as either private or confidential. Private data is information that gena~a(]y cannot he given to the public but can be given to the subject of the data. Cmifidential data is information that generally cannot be given [o either the public or Ihe subject of the data. The City of Roseville is collecting the information to determine qualifications to serve on a Citizen Advisory Commission. YOU ere not legally required to provide [his information. I-Towevet, if you do not supply the information, you may not serve on a Cilize<r Advisory Commission. Other persons or entities authorized bylaw [o receive this information are Cily Council members, staff, residents of Roseville find in[ei'ested othcr5. l w~detstand that all information provided iu this application, except my telephone numbers, fax number acid email address, may be disuibuted by the City fo the public including, but not limited to, being posted on the City ofi2oseville website. I agree to waive any and all claims under the Muuiesota Gorrernment Data Practices Act, or any other applicable state and federal law, that vi any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided. I understand that the City will not publish my phone or fax nttmbers or email address without Iny atlthorizatiml and~do hereby allow the City to publ/~ish (check all that apply). home telephone number _iwork telephone number -other telephone number home fax number -work fax number Mme email address w rk emai address ~~ ' Zature of icatrt at of Application Apylicnrimr 061/29' Other Comments; (Inclurte anyfarrther information you would like the City Council to consider- or• that you feel is relevant ro the appofnunent l~ou are seeking. You may also atdach other ntaterials you