2. Application for Reappointment

   For volunteering to serve on a Board or Commission

4. Name of Board or Commission*
   -- Select One --Affordable Housing CommissionArts CommissionCivil Service CommissionDiversity, Equity, and InclusionEllensburg Business Development AuthorityEnvironmental CommissionLandmarks and Design CommissionLibrary BoardLodging Tax Advisory CommitteeParks and Recreation CommissionPlanning CommissionPublic Transit Advisory CommitteeSenior Citizens Advisory CommissionUtility Advisory Commission
6. Current Term Expires*

   1. May 31 of current year
   2. December 31 of current year
8. First Name of Member*
9. Last Name of Member*
11. Address 1*
13. Address 2
15. City*
16. State*
17. Zip*
19. Phone Number*
21. Email Address*
23. I am requesting to be considered for reappointment for another ____ year term.*
    -- Select One --23456
25. Why are you seeking reappointment?*
27. Type your name as your electronic signature*
28. Date*
    Date
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field