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Morgan County Advisory Board Application Morgan County Hospital Authority Applicant Information: Full Name Address Mailing Address (If different) Telephone-Home Telephone-Work I reside in Commission Board interested in serving on: Hospital Authority Background Information: Occupation/Employer Education: Do you have any experience in the field you are applying? If so explain. Contribution/Intentions: What do you feel will be your biggest contribution if appointed to this board/position? Other Comments or Information: This board meets the last Thursday of each month at 5:30 P.M. in the DFACS building at 2005 South Main Street, Madison, GA. In addition, there are Special Called Meetings on an as needed basis. Policy: I understand the obligations and commitments required by this board/position. If appointed by the Morgan County Board of Commissioners, I agree to serve and faithfully execute the obligations and commitments of said board/position for the duration of the term of appointment. In all respects, I will uphold the ordinances and policies of Morgan County and all municipalities in a professional and courteous manner and fully divulge any and all potential conflicts of interest. Signature Date