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Special reasons for wishing to serve on the Board or Commission: <br />What advisory panels, <br />061 <br />6 tIak:)DCA-hv e <br />issions have you previe <br />1 <br />Please list any training or experience you have that would be beneficial to serving on the Board or <br />Vol <br />Are o�v��blefo attend board meetings <br />If no, please explain? _ <br />ing the day or evening M -F? <br />es [ ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: 5'ns�� <br />kl ' afl 1� 0 Phone: (H) (W) <br />cl P <br />Address,9tr!`. City:.SWA7,, State: Zip:r F- <br />• Name: 4 �1 I'Itc.3nc: (H) (W) 5 b q 1619 -- 3 Y 2.O <br />r <br />Address: i Si5 City 4� Stale: zip: 1 If <br />Your application will be placed with others interested in serving on the same board or commission. <br />When a vacancy occurs on the Board/Commission in which you have indicated an interest, the <br />Board of County Commissioners may desire to conduct an interview. <br />-71 YOUR SIGNATURE: _ _ _ _ W I Date: I 1 I 1(-=P <br />Please return completed form to; Board of Kittitas County Commissioners <br />205 W. 5`h, Room 108 <br />Ellensburg, WA 98926 <br />509.962.7508 FAX: 509.962.7679 <br />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />r <br />