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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 <br />Commission: 5Pe co <br />have that would be beneficial 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 />A<Yes [ ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: 5 -jot Phone: (H) 95R-65'12 _[w'' C-' <br />Address: 7e tJ. Per City: j leAs6vig State: Zip: <br />• Name: Nk UTc I PF Phone: (H) C -19 - y (W) <br />Address: i qqr 51'io5m:jS K,;) R,Aa city E11C-fW b,.,r State: (J --j zip:'%E E 26 <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: utdAV L' A Date: <br />\j - — i <br />Please return completed form to: <br />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 />3--1q- KV, <br />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />