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11 <br />0 <br />n <br />U <br />gram <br />the city that works for you <br />Advisory Commission & Task Force Application <br />Date def IL • Zq, 20 lU <br />General Information <br />Name I vy � l <br />Last <br />Address <br />City, State ZIP �) -ew B G- u <br />-,�C•CZ 4'� JI <br />M.I. <br />L� <br />�l <br />Phone 1— l�� —3` i�CJ Wel (4—C: L'K& <br />Home Business Cell <br />Email Address <br />Commission/Task Force <br />./ Public Safety Commission <br />Planning Commission <br />Park, Recreation & Environmental Comm. <br />Availability (Check all Preferences) <br />_ Economic Development Commission <br />Civil Service Commission <br />NWQ Financial Strategies Task Force <br />v1 After work, early evening _✓ Evening, after supper Early morning <br />List specific days or times you are not available <br />Personal Information <br />List any related work/education experience: <br />