2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Phone Number
14. Available to public

    If selected to serve, would you want this phone number available to the public?

    1. Yes

    1. No
16. Email Address
17. Available to public

    If selected to serve, would you want this email address available to the public?

    1. Yes

    1. No
19. Present Employer
20. Job Title
22. Previous Governmental Bodies/Elective Offices you have served on, Position/Office held and Dates:
24. Civic or Charitable Organizations to which you have belonged, Position/Office Held and Dates:
26. What special Interests/Skills/Talents would you bring to the Parks and Recreation Commission?
28. Special Awards or Recognitions Received
30. Please state the reasons why you want to become a member of the Parks and Recreation Commission
32. Is there any other information that you feel would be useful in reviewing your application?
34. Are you associated with any Organizational/Employment that might be deemed as a conflict of interest in performing your duties if appointed?

    1. Yes
    2. No
36. What Organizational/Employment do you deem as a conflict of interest in performing your duties if appointed?
38. City policy directs that all appointed advisory board members do not vote on matters where a potential conflict of interest exists. Would be willing to abstain from voting if such conflict arises?

    1. Yes
    2. No
39. How many Parks and Recreation Commission Meetings have you ever attended?*
41. By signing below, I acknowledge that I am a resident of Spring Hill, over the age of 18 and all the information is true and accurate.
    Please print form and sign in the space above.
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43. 1. Receive an email copy of this form.
44. Email address

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45. Submit Submit and Print

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