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Special reasons for wishing to serve on the Board or Commission: <br />WhatJa�sory panels, Boards/Commissions have you previously served on? <br />/IL OACA <br />Please list any (raiding or experience you have that would be beneficial to s ving on the BCoard�`' <br />Copiniss)OH: r s*u r 4. beneficial <br />e r- 0 T � Ll, c <br />liH <br />Are you available to attend hoard meetings d.�] ri�] the day or eni g M -F? <br />If no, please explain: _ _5v , 2. C' s C, f <br />-HV�ea f ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />/ C <br />• Name: _T 1 4 (l��� Phone: �H"j 4 7f — 138(0 (�N ) <br />�_ V 6 FCiry:_ C L E State: Zip: <br />J Zz <br />Address: _ //--�r. � s v�_ <br />■ Name: ^ H r k4. L� 5 4 t_ _Phone: (H) (W) <br />Address: Wb FW Q s, 6 City K�� State: Zip: <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 maLdesire to conduct an interview. <br />YOUR SIGNATURE: '&_ _Date: <br />Please return completed form to: Board of Kittitas County Commissioners <br />205 W. 5th, 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 />