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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 />vt i �ti r4l W 81r— <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 whocouldspeak to your qualifications for the desired appointment: <br />Name: i�h �=/` �� — Phone: (H) — <br />Address: City: State: <br />• Name:Phone: (H) <br />Address: (' i ry <br />Zip: <br />(W) <br />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 may desire to conduct an interview. <br />YOUR SIGNATURE:— Date: 3 � ol <br />Please return completed form to: Board of Kittitas County Commissioners <br />205 W. 5"`, 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 />