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1JRE 1 M <br /> the rlty that *irks kr you <br /> Advisory Commission Application <br /> Date Nov: j 5,10 <br /> General Information <br /> �.o F <br /> Name sJ 9r-r <br /> Last First M.I. <br /> Address 5 L4 5 ti "i (/- ki 414/ <br /> City, State ZIPNj 13 ikAif l 12 <br /> Phone C 5 ! 143 L1 5910 <br /> Home Business Cell <br /> Email Address <br /> Commission/Task Force <br /> Public Safety Commission Economic Development Commission <br /> Planning Commission Civil Service Commission <br /> Park, Recreation& Environmental Comm. <br /> Availability (Check all Preferences) <br /> 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 />