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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 the Board or <br />Commission: ::r Glrxjg_ gep j U ecj us .5t.ta �rfn t ►ac�r �� � ?ci, ,.� + <br />vt . tri J 1 o+.iq Co ,n� ni . A2e-4 <br />Are you available to attend board meetings during the day or evening M -F? <br />If no, please explain: <br />['Yes [ ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name:�',,e,! u cE,r,n4Ni Jl Phone: (H) SYJ-_3L)b-3Z'*I tW) <br />Address: fN 2,y dE& S City: (�s�StaEe: to Ct Zip: <br />• Name: :1L6n,,eS W^.3a. v Phone: (H) e?6,4 - `i 5Y (W) <br />Address: c.,R.*r.J City j9/.1eq5bv,y State: W'1 Zip: '/ Z(� <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: <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 />