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2. City of Eloy Boards/Commissions/Committees Application
4. Today's Date*
   Today's Date
6. Which Board, Commission or Committee are you applying for?*
   -- Select One --Board of Adjustment Parks, Recreation and Library Advisory BoardPlanning & Zoning CommissionRevitalization Commission
8. Title*
   -- Select One --Mr.Mrs.MissMs.
9. First Name*
10. Last Name*
12. Home Address *
14. City*
15. State*
16. Zip*
18. Mailing Address (if different from above)
20. City
21. State
22. Zip
24. Phone Number *
25. Cell Phone Number *
26. Work Number
28. Email Address*
29. Are you older than 18 years of age?*
    -- Select One --YesNo
31. Do you live in the incorporated boundaries of Eloy?*
    -- Select One --YesNo
32. How many years have you lived in Eloy?*
34. Name of Employer *
35. How long?*
37. Please list any organizations with which you have been affiliated*
    Please include community, civic, professional, social, education, cultural or athletic organizations.
39. Education*
    Briefly describe your educational background (high school, college, vocational training, etc.)
41. Additional Information
43. Please describe any relevant experience which will help you serve on the Board or Commission of your choice*
45. Certification *

    1. By checking this box you are certifying all the information contained in this application is true and complete to the best of your knowledge.
47. Signature*
    Typed name is acceptable.
48. Date*
    Date
50. Resume
    Resume is not required.
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field