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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 />Are you available to attend board meetints during'the day or evaninu 1LF9 <br />Please furnish two references who could speak to your qualifications for the desired appointment <br />• Name: QA ITM �� Phone: (H) <br />Address: ✓U A-Ue" ' hy: o 1 C&L {>V 7rp ' ! `f t ! <br />11,E ?/� State: <br />� Name: 11M 1�r}�yy112X L� { y�Phone: (Fl ,-ato <br />I}�$�r(W)y� 1 <br />Address: �10 S (-t tt��rmo-1-�i 1 City �o at�� State:ti(ji + Z.ip: � �! L) <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. We will retain your <br />application for 2 years from the date it is received. i } <br />YOUR SIC,NAT ]RE: Date:?A"' <br />! d <br />Please return completed form to; Board of Kittitas County <br />Commissioners 205 W.5th, Room 108 <br />Ellensburg, WA 98926 <br />509.962.7508 or bocc@co.kittitas.wa.us <br />PLEASE NOTE: ALL APPLICATIONS SUBMITTED TO THE BOARD OF COUNTY <br />COMMISSIONERS FOR APPOINTMENT BECOME OFFICIAL PUBLIC RECORDS. <br />