Citizen Leadership Form
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I, ____________________________, hereby apply to perform public
service on the following municipal authorities, boards or commissions:
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(a)
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(b)
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(c)
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1.
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Name:
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2.
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Address of Residence:
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3.
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Phone Number:
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4.
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E-mail Address:
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5.
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Education, prior volunteer or work related experience, or other
civic involvement which could be of use to authorities, boards or
commissions:
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