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Janice Ellis <br />mmm~ <br />From: support@civicpius.com <br />Sent: Wednesday, May 11, 2011 3:16 PM <br />To: Janice Ellis; Denene Taylor <br />Subject: Oniine Form Submittal: Application for Boards / Committee / Commission <br />If you are having problems viewing this HTML email, click to view a Text verston. <br />Application for Boards / Committee / Commission <br />First <br />. . y~ ~ <br />Donn* .L ; ' <br />~ <br />,4ttdr•essi" , <br />Ci#y"' <br />i~~r~: ~i~ Or <br />~ Staw TX zw Q0 .46W <br />l # <br />Telepttortex <br />` <br />(903) 249-M3 <br /> <br />(903) 123 <br />t } Akpwt A0W <br />Areas of t " <br />~ . C~ <br /> <br />, <br />11, ~ tc ~~nent <br />Pub-ft <br />I l' <br />~ <br />~ ~r~ . a <br /> <br />~milaelloners <br />[ j Stiet'Advimy Boarti <br />~ ~or <br /> <br />Piease nate any speciaf knowkKigs, educattar►. a' <br />expefiencco you tave t#at is apPkAWO tD tte kuwAion <br />of the boattL c.wnmmission, or cornmiitee o# mterest <br />(aftach a al pages If necessary). If ap , <br />list dates of setvice on any C}ty baartiis, <br />commissiam, ac comr+nittees. <br />Certification and Authorizationn <br />I acknowledge M I am awaite arettF agree to the prohibifiions of the C+ty of Paft CttarW' and t►e <br />nepotism and e.onflic of ittterest of appaiMees to CI#.jr boards, comsnWians, a►nd cormnittees. i <br />attend at Ieast 75 percent of aN regutar meettngs and shaN nat hava any daftluent dnes <br />understand that the number of passiticxtis on a given baard, eomrtnWaior►, or camt'rtifte is knited i <br />however, it 1 arn not appair►ted, t agree to be placed in a detabase for possbe ftWm notificatliori <br />informatioo giverrby rre In this appRoatican is ttve ar►€t ctti~ed and any Ugse itdvrnuftt or twom <br />disqualifica#ion. I aufhorize the City of Raris to verify al# infarmation provided irr tteis appficattort.1 <br />Locai Govemment Code, I understand that information provided in this applicaton may `be avall; <br />[X] Agree <br />` indicates required fields. <br />t ? Disagree <br />The following form was submitted via your website: Application for Boards / Committee / Commission <br />i <br />~ , 19'7 <br />