Laserfiche WebLink
Robin Norwood <br />From: Janice Ellis <br />Sent: Monday, June 13, 2011 9:09 AM <br />To: Robin Norwood <br />Subject: FW: Online Form Submittal: Application for Boards / Committee / Commission <br />Please make fourteen copies (can be front and back). I need this for the meeting tonight. <br />From: support@civicplus.com [mailto:support@civicplus.com] <br />Sent: Monday, June 13, 2011 9:01 AM <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 />TMe Paris Oty Cowxi4 ~ ~ ft cwwnWae!d &ndi' ls wt* as`tt~ Wto #0 W0 . .v , %014e, Far, 5~~~ ~ ~ W"Its <br />stancling *ad corW .'IeF ~rW,,, ~ <br />~4t01r1~1~kR [C~.~it~,,~i.to~ <br />GtUBri~'f ` IY14'~~l ~ r~'[~I4R1+ vr~y w1-tv an-- • - - <br />First Name'"' Rw'idy L8st ' ftmch <br />Iwt~" <br />Address" 338{t 1Mi#ow Senci <br />CityK Poft 8tos* ; TX ZI0"` 0 76W <br />: <br />()7501 <br />Telephone (803) 78t-5184 <br />(903)1234587"` <br />[ l MW Advisary Soard pq' Mu . <br />our <br />Areas of trtterest* [ ] SuildirV 8, Stant3ards Gomminii~t & <br />pwmft L 3 clv# service COMMISSW ~ 3Putk L <br />t l E+~nornic ~vs#ct~nt ~r~ratkarr ; +~,nu~! ~ I l HE#stwic Preaervation COMM~"On zoft Board of A*wtrnertt <br />[ ] Nousing Authorltyr Baard of <br />Cctrtttrtissioners <br />[ ] Sb?eet Acivisary Boarci <br />Ptease note ar~ty special tmowledge, educagan, 1 have !,een senring on this ccxnm#ssio't for severat YeaFS.1 hwe constderakl9 <br />or expenom ' you have thaf is app~kable to ft knomftdge of budget comornS, membership and sore as tte acte mornbw o# tw <br />funetian of the board, cammisstion, or band as ouUined by the Band CcrmmMion byrWm asWASW about 8-10 ' ago. <br />committee of irtter+est (aftach adctffiOnat Pa9es if <br />necessary). ff applicabte, list dates af servics <br />on any City bae+cf.s, eamrnissior►s, or <br />committees. <br />Certification and Authorization <br />I acknovukwdge that 1 arn aware and agree ta fhe ptoMitiarrs of the Cify of Paris ChaftF and the iwA.of t~ State aF Texas regarft <br />nepotisrn and conf#icts of trt#erest of appoOtm to City bowds, wmnni s, atW laiso 'if appointed tvAN <br />attend aE ieast 75 perconi of aN regutar meefts and shall not have arty dekxWM trx4et4edrtess to the City c'urft my ttttm, t <br />understand that the tlumber of pasifts art a given board, commWsion, or camrtaifte is Hmfted ani that t may not be appointed; <br />however, if 1 am nat appointed, k agree'to be placed in a datatase fot po"bte futuro nadkaftrt of topim of irAet+ost. Eoartffjt that the <br />information given by r►e in this apptica#ior► is true and r.arrect artd any fatw MfwmafJDr► or misre is wftent gmonds far <br />disqualif►catron.l authariae ths City+ of Paris to verity aN irrfarrnAtior► pravidet! in tltiis ..tn. ln aWoMance wwtt SecLion 562 o# the <br />lacai GowemmeM Cocte: r UMdB( ESL3fKI ftt IFlfOrt118Eion p(E)YWBd t►1 ttiS Bppkafi4F'F 1'my be ava1Iable, to Vie Gubitc"~ ~~WftV <br />[X] A9ree [ } Disagree <br />1 <br />149 <br />