2. Name of Board/Committee/Commission *
   Please provide the name of the group you have been appointed to serve on for the City.
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Select one*
    -- Select One --MobileLandline
15. Alternate Phone Number
16. Select one
    -- Select One --MobileLandline
18. Email Address*
    If no email address enter Not Applicable.
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field