HomeMy WebLinkAboutAgenda Bill 4.A-Drew 11/15/2010J
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Instructions: Use this form to apply to -serve on any of the City of Petaluma, Californ Boards,
Commissions, or Committees. Please fill out the form completely. If a question does not app r
write N/A in the space provided. When completed, please forward to the City Clerk's Office
Petaluma, I I English Street, Petaluma; CA 94952. All applications are reviewed by the City Council.
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Are you g erect voter �n Petalurna�
If so f hom ong?
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Board(s) Interest* �
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*Note: To e,rve on the Senior Advisory Committee, you must be age 55 or above.
Hof
attended this—��
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Have on or a plied for
H Have you a`meefing of
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YES ❑ NO
® YES NO
DREW, ROBIN
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June L, oAo 1 0
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aWhat Special : Interests / Skills /Talents would 'you,brng?to this Board, Commession, or Committee
On.
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College, Professional, Vocational Schools Attended (Major Subject, Dates, Degree /Date):
N A
Special Awards or Recognition Received:
ti /fl
Please state reasons why you want to'become a member of this Board, Commission or
Committee, including what specific objectives you would be working toward as a member of
this advisory body:
Sam co- nwrwuz. of fhe. (!o2onra RoA4PRO��
SmAR,T STAtroN
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Is there any other information that you feet would be useful to the City Council in reviewing
your application?
Z a n- also Cz> - ownerZ, 6-C AD-, 5 AO-Ae , '5
RCROSS
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Are you associated ,with any O /Employment that might be deemed a conflict of
interest, in performing your duties if appointed this position?
YES
NO
If yes, please state name ° of Organization /Employment:
City "polic directs all a bod e
y ppointed. advisory y m tubers not to,,vote on matters where there
exists a potential conflict of interest: Would you be;willing to abstain from voting if such a
conflict arises?
YES ❑ NO
How did you hear about this opening ?.
PR�ss �EMOC.P-A i IvGLs FAPO
Applicant's Signature
Date
Revised August 12, 2008