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Special reasons fon- wishing to serve on the Board or Commission. <br />My family and i have lived in Upper County for 10+ years, ! have been a memberof the <br />HUMMUNWIMI <br />TMftlts <br />.. <br />What advisory panels, Boards/Commissions have you previously served on? <br />;r. r <br />it . • f .� ' #.." • �,�.. � .� ,- _ , <br /># f d W - <br />Are you available to attend board meetings during the day or evening -F?� Yes [ ] No <br />If no, please expl is <br />Please furnish two references who could sped to your qualifications fon° the desired appointment: <br />* Name: Kim Headrick Phare: ) <br />Sr;iaev� <br />Address: Z�6 SA_lffOs City. 00 IState,,: zip: `_ t <br />Menne: Tuesday Basch Phone: (fit) 517�-_����' <br />Address: PC), city klusa,� � State: �-V4 zip: It.�'�VI <br />Your application iii be placed with others interested in serving an 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 array desire to conduct an interview, <br />YOURSIGNATURE: � �"� late: i <br />Please return completed fervor to: Board of Kittitas County Commissioners <br />205 W.5"', Room 108 <br />Ellensburg, WA 98926 <br />509,962.7508 FAX- $09.962.7679 <br />