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Janice Ellis <br />From: support@civicplus.com <br />Sent: Wednesday, May 11, 2011 6:45 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Online Form Submittal: Application for Boards / Committee / Commission <br />If you are having problems viewing this HTML email, click to view a Text version. <br />Application for Boards / Committee / Commission <br />Addtess"' <br />City'" <br />Tetephane <br />(903)123-4567"` <br />Areas of I t' <br />Please nate any special know{edge, educgtian, or <br />experience you have ttW is appficaMe to the fur►ction <br />of the board, commissictn, or comtni#tee at interest <br />(attach additional pages if'necessary). If app4icable, <br />list dates of gsrviee on any City boards, commissions <br />or committees. <br />Certification and Au#horization <br />I acknowledge that I am aware and agrae to the prohibitions of tt►e Cityr af Paris Charter and the laws of the Stat+s of Texas reorciing <br />nepatism aruf conflic#s of interest of appoirrtees to City boards, cammissions, and committeos. I atso certify that if appoin#ed f wiit <br />attend at least 75 pencerrt af alt regular meetings and shalt not have any detinquent kidebtedrtess ta the City dciuing rny term. I <br />understand that the numtler o# pasitivns on a given board, commisWon, or cammittee is iimitett and that t may ntat be appointod; <br />however, if t am not appoirfted, 1 agree to be placed in a database for pmible future rtotif'icaNon af topics of intsarest. I Certify that the <br />information given by me in #his application is true and correcf and any fa1se infowmation or rnisreprew►dation is sutfieient grawuis for ' <br />disqualificafian. k au#harize the City of Paris to verify att information provi;ied in this appfiCadvn. In accordance with Section 552 a€ the <br />Local Govemment Code, I understand that informatian provided in this applicat3on may be avaitabte to the pubffc upcrn request'` <br />[X] Agree <br />* indicates required fields. <br />[ ) Disagres <br />The following form was submitted via your website: Application for Boards / Committee / Commission <br />11 113O <br />Fi1'St N8m6* <br />