2. Contact Information
4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number
17. Email Address
19. I Am Interested In Serving On The Following Board(s)

    1. Human Relations Board
    2. 911 Board
    3. Building Contractors Board
    4. Solid Waste Management Committee
    5. Historic Preservation Advisory Board
    6. D.B. Library Board of Trustees

    1. Parks & Recreation Commission
    2. JC Public Housing Authority
    3. JC Airport Advisory Board
    4. Plumbing and Mechanical Board
    5. Metropolitan Planning Commission
    6. Economic Development Commission
21. 
    If I Am Selected To Serve On The Board(s), I Will Participate.
    
    
23. Date*
25. Signature*
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27. 1. Receive an email copy of this form.
28. Email address

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29. Submit Submit and Print

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