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Special reasons for wishing to serve on the Board or Commission: <br />� �- �tti►.n �� zs �— ���CJ�1 ', 5 <br />_ �-� � _ <br />What advisory panels, Boards/Commissions have you previously served on? <br />Please list any training or experience au have that would be <br />Commission: A" -04.i .,t�bA*O'P �A 1L,. <br />r <br />1 to serving on_the.Board or <br />Are you available to attend board meetings during the day or evening M -F? <br />If no, please explain - <br />Ayes [ ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: 0�� � t 1`GaA _Phone: (H) (W) fi ^ Iy(» <br />Address:�� �} �} G - {'.•-.. City: 51�-,n- �6v�— tate: Zip:_ Z <br />• Name: �� �+ � � � ,Phone: (H) (W) .7U�_' ��3 • l N � � <br />Address: N6 Z AI . U1"A City State: —V)A Zip: 6 toa 3 <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: Date: • Z z' <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 />