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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 />_ /Vv/�lG <br />Please list any training or <br />Commission: P--4LY � <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 />Ayes [ ] No <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: ,_;+' %K CZ40AI _ Phone: (H) 5,V AL( <br />Address: & 7' C�dIfe:Iff (f�T- City: ,moi State: Zip: <br />■ Name <br />sl /=rC YVreJ Phone: (H) <br />Address: l 7I� ;5.X, fIPS City L State <br />(W) <br />" Zip: —T�`� <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: <br />Please return comp tod form to: Board of Kittitas County Commissioners <br />205 W. 5tb, 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 />