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Special reasons for wishing to serve on the Board or Commission: <br />i- S'�G �tp-usc�Ch <br />What advisory panels, Boards/Commissions have you previously served on? <br />Please list any training or experience you have that would be beneficial to serving on the Board or <br />Commission: ,Q I kad Jh�t- <br />Are you available to attend board meetings during the day or evening M -F? PO Yes [ ] No <br />If no, please explain: <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: -` 'r3f13-OBsT _ _Phone: <br />Address: e0 -Rtp—, -i— <br />City: py _State:_AL& :��4_ <br />• Name: 7Q by c(- C�� r� Phone: (H) <br />Address: (2Q•^ �`L'I�i►r &P Cityj4t_19] ,bu 7, State: dip: Zto <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 />YOUR SIGNATURE: AA- � Date:, <br />Please return completed form to: Board of Kittitas County Commissioners <br />205 W. 5`b, 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 />