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2. Name
3. Email Address
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. Length of Residency
15. Position Applying For:
    -- Select One --Township BoardPlanning CommissionZoning Board of AppealsBoard of ReviewMcFarlen Library BoardDowntown Development Authority
17. Why would you like to serve on this board?
19. Applicable experience:
21. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature
25. Date:
    Date:
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field