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T'm very exci�ed about the possibility of being selected to serve on the Park and Recreation Cammission. I would consid�r i� a tremendaus honor to serve this great and wanderful community, especia�ly during this tame of economic crisis. I understand that a11 information pravided in this app�icatzon., except my telephorie number, fax number and email address; may be distributed by the City to the public including, but no� limi�ed to, being pos�ed on the City ot RosevilZe website. I agzee to waive any an.d all claims under the Minnesota Government Data Practices Act, or any other applicab�e sta�e and federal Iaw, tha� in any way related to the dissemination to the public of informatian coatained in this applicatian that wou�d be classi�ied as priva�e unde� such laws. I understand tihat I may contact �he responsib�e authority for the City of Raseville af I have any questions regarding the public or pzivate nature of the �riformation provided.: Yes r understand t�at t.he City will not publish my phone or fax numbers ar email address without my authorization and do hereby a11ow the City ta publish (check a�l that app�y} „ Home �elephone number Dayt3me Phbne: 551-484-9184 Evening Phone: ceii Phone; Home Phone (if different}: Wark Phone (if different): Home Fax: work Fax: Home Email: Work Emai1: S�uden� Application: No If yes, pleas� list your gr�de: May we contacti you using your work email or fax?: No I have read and understand the staeements on this form, and I hereby swear or affirm that the statements on this form are true. : Yes Additianal Informa�ion: Form submitted on: 2/12/2009 9r09:36 PM Submitted from �P Address: Form Address: http://www.cityofroseville.com/forms.asp?FID-237 2