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2. Select the Board, Commission, or Committee applying for

   Select all that apply

   1. Building Trades Board
   2. Community Corrections Board
   3. Community Housing Board / Land Bank
   4. Emporia Enterprises
   5. Emporia Human Relations Commission
   6. Emporia-Lyon County Convention and Tourism Committee
   7. Emporia-Lyon County Joint Board of Zoning Appeals
   8. Emporia-Lyon County Metropolitan Area Planning Commissions

   1. Emporia Main Street
   2. Emporia Public Library Board
   3. Emporia Recreation Commission
   4. Golf Advisory Board
   5. Multi-Use-Path Planning Board
   6. Natural Resources Advisory Board
   7. Regional Development Association of East Central Kansas Board
   8. William Allen White Community Partnership
4. Personal Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Home Phone Number*
19. Business Address*
21. Business Phone Number*
23. Occupation*
25. Email Address
27. Residency Information
29. Length of Residency in Emporia*
31. Are you a registered voter*

    1. Yes
    2. No
33. Education and Hobbies
35. High School
37. College
39. Trade or Business School
41. Hobbies
43. Organization Membership Information
45. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
47. If yes, which
49. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
51. If yes, which
53. Please list organization memberships and positions held
55. Please List Areas of Special Interest
57. Please Enter Basic Resume Information Below
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59. 1. Receive an email copy of this form.
60. Email address

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61. Submit Submit and Print

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