Document Douglas_doc_b17265ca13

I:/Cheryl/Forms/Application for Boards, Commissions, Focus Groups CITY OF DOUGLAS Volunteer Application Name of Applicant: Street Address: Mailing Address: (if different from above) Home Phone: Cell Phone: Office Phone: e-mail: Resident of the City of Douglas?  Yes  No (requirement only for Commissions) I am interested in serving on (can select more than one): Boards/Commissions:  Douglas Planning Commission/Board of Adjustment  Historic Preservation Commission  Converse County Tourism Promotion Board  Douglas Housing Authority Board  Federal Aid to Urban Systems Board  Other: Focus Groups:  Why are you seeking the appointment(s)? Dated: (Signature of Applicant) For Office Use Only: Selected for: Length of Term/Dates: Additional Information: