Kenansville Boards & Commissions Application

Advisory Board/Committee/Commission interested in
I understand that this application will be kept on the active file for two years only, and I hereby authorize the Town of Kenansville to verify all information included in this application.
Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####
Email
Occupation
Business Address
Current volunteer activities/other Boards & Commissions
Why do you want to serve on this board?
Certification

I certify that I understand the 75% attendance policy established by the Town of Kenansville Board Appointment Policy. I further certify that I am aware, if my attendance drops below the 75% attendance requirements, that I may be removed from said board appointment by the Board of Commissioners.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY