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* indicates required fields. <br />The following form was submitted via your website: Application for Boards / Committee / Commission <br />First Name: Randy <br />Last Name: Bunch <br />Address: 3380 Willow Bend <br />City: Paris <br />State: TX <br />Zip: 75462 <br />Telephone <br />(903) 123-4567: (903) 784-5184 <br />Areas of Interest: Municipal Band Commission <br />Please note any special knowledge, education, or experience you have that is applicable to the function of the <br />board, commission, or committee of interest (attach additional pages if necessary). If applicable, list dates of <br />service on any City boards, commissions, or cornmittees.: I have been serving on this commission for several <br />years. I have considerable knowledge of budget concerns, membership and serve as the active member of the <br />band as outlined by the Band Commission bylaws established about 8-10 years ago. <br />Certification and Authorization <br />I acknowledge that I am aware and agree to the prohibitions of the City of Paris Charter and the laws of the <br />State of Texas regarding nepotism and conflicts of interest of appointees to City boards, commissions, and <br />committees. I also certify that if appointed I will attend at least 75 percent of all regular meetings and shall not <br />have any delinquent indebtedness to the City during my term. I understand that the number of positions on a <br />given board, commission, or committee is limited and that I may not be appointed; however, if I am not <br />appointed, I agree to be placed in a database for possible future notification of topics of interest. I certify that <br />the information given by me in this application is true and correct and any false information or <br />misrepresentation is sufficient grounds for disqualif cation. I authorize the City of Paris to verify all information <br />provided in this application. In accordance with Section 552 of the Local Government Code, I understand that <br />information provided in this application may be available to the public upon request.: Agree <br />Additional Information: <br />Form submitted on: 6/13/2011 9:01:09 AM <br />Submitted from IP Address: 74.193.83.121 <br />_1 150 <br />