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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: <br />Are you available to attend board meetings during the day or evening M -F? A]'�'es [ ] No <br />If no, please explain: <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: J C)t� SA Vii.` oPhone: n6 <br />Address: [3KrCK-,w=LL- TZD city: CIL6- 02(L State:v) Zip: <br />• Name: Phone: (H) eel) 71P7-2 NO(W) <br />Address:. q551 N Al EOVy— -9D City aC53� )96- State: U`44- Zip: W K'2 <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: C` Date: s <br />Pled,se return completed form to: Board of Kittitas County Commissioners <br />205 W. 5t", 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 />