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Special reasons for wishing to serve on the Board or Commission: <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 he Board or <br />Commission: • <br />eb <br />Are you available to attend board meetings during the day or evening M -F? es [ ] No <br />If no, please explain: AI 12L-1� P ✓� <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />+ Name: <br />41 Phone: Phone: (H) <br />Address: �/1I1�' Ciry: State: Zip: `�� <br />• Name: 10Ai IVA, Phone: (H) r <br />�L 4+�G/��,.` _ � � State: Zip: <br />Address. Ol�1 f)MMA <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 fn which you have indicated an interest, the <br />Board of County Commissioners may desire to conduct an interview. <br />YOUR SIGNA' <br />Date: <br />Please return completed form to: Board of Ki"tas County Commissioners <br />205 W. 5th, Room 108 <br />Ellensburg, 'WA 98926 <br />509.962.7508 FAX: 509.962.7679 <br />PLEASE NOTE: ALL APPLICATIONS SUBMPUTTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />