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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 />I�iCN1.P� <br />Please list any <br />�yt�ai�niiag o'r1 e p ie cc you haveyth t wouldbe beneficial to serving on the ox d'`or <br />Commissil f °1. 5' P. -r W'10_71 S� a s.i A 1' I— ��� SkZ A& ! )A V --A. IfJli✓r Yr i4,,, ('O e- �,_A H.7 <br />9—Y <br />Are you available to attend board meetings during the day or evening M -F? N Yes [ ] No <br />If no, please explain: <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />* Name: i � �C. L.f Phone: (H) [W). <br />Address: '+5Ag41,\ i i 1[ovi Stree�- City: 45VeAAVr State: \4zip:1872(19 <br />e Name: Poo C\ I'' e_+z Phone: (H) (W) _ (Dg(- 'f61-140 <br />Address: 14 o;MtA AvNmvG -city. yaV'i+mk -State- �2ip: <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: 2D <br />Please return completed form to: Board of IGttitas 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 />