Reappointment - Board, Commission / Committee

2. Date Applied*
   Date Applied
3. Seeking Reappointment for Board, Commission or Committee *
5. Name*
7. Address*
9. Mailing Address*
11. E-mail*
13. Phone*
15. Tell us about any Professional or Civic Organizations you are involved in:
17. Briefly describe why you would like to be reappointed to the above Board, Commission or Committee*
19. How often would you be able to attend meetings?*

    1. Weekly
    2. Twice per Month
    3. Monthly
21. Might any action taken by this Board, Commission or Committee directly affect you (or your employer)?*

    1. Yes
    2. No
23. Do you believe that there would be any conflict of interest if you were reappointed to this Board, Commission or Committee?*

    1. Yes
    2. No
25. Are you a year-round Marion resident?*

    1. Yes
    2. No
26. Are you a registered voter in the Town of Marion?*

    1. Yes
    2. No
28. Signature:*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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