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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 y u have that v ould be beneficial to serving on the Board or <br />Commission: Com' ►' �r P <br />i I <br />V1t . �i.l QLIL�-- <br />9V -CS!+ VN' C.CL1'C' {- <br />0-o,^Vti.y W t tt <br />Are you available to attend board meetings during iEie day or even\ing -F? }j Yes [ ] No <br />If no, please explain: �+.� V -<i <br />Please furnish two references who could speak to your qualifications for the desired appointment: <br />• Name: GaeC4ck. PhoitC. (I-1) (WUSI) 99J-42-73 <br />Address: k 7I,4CP city:_C��; �"� state: _LoeL Zip: gBo4 � <br />• Name: 'M`f': ► � _rnune: (H) (W) f fed } :19 C- ' T?S 2— <br />Address: <br />Address: ;-% r`,�lrt' _� �aSC••^tCity M a State: Qd,- Zip: Q <br />Your application will be placed with othere 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 SIGNATURC: �\� Date: i S <br />Please return completed form to: 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 />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />