Committee Application
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315 South Lowry Street Smyrna, TN 37167 (615) 459-2553
Committee Application
Date: _____________________________ Committee Recommended/Requested: __________________________________________ Name: __________________________________________________ ______________________ Address: _______________________________________________________________________ Home Phone: ___________________________Cell: _____________________________________ Registered Voter?
Yes or No
Years of residency in Smyrna: _____________________
E-mail Address ___________________________________________________________________ Current Workplace: _______________________________________________________________ Job Title: _________________________________ Length of Employment: ___________________ Business Address: _________________________________________________________________ ______________________________________________________________________________ Education: ______________________________________________________________________ ______________________________________________________________________________ Past/Current Community Involvement: __________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Professional Organizations: __________________________________________________________ ______________________________________________________________________________ Explain why you would like to serve on this committee: _______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Do you know of any potential conflicts: __________________________________________________ Return form to the Town Manager’s office at above address. Deadline- March 3, 2009
Committee Application
Date: _____________________________ Committee Recommended/Requested: __________________________________________ Name: __________________________________________________ ______________________ Address: _______________________________________________________________________ Home Phone: ___________________________Cell: _____________________________________ Registered Voter?
Yes or No
Years of residency in Smyrna: _____________________
E-mail Address ___________________________________________________________________ Current Workplace: _______________________________________________________________ Job Title: _________________________________ Length of Employment: ___________________ Business Address: _________________________________________________________________ ______________________________________________________________________________ Education: ______________________________________________________________________ ______________________________________________________________________________ Past/Current Community Involvement: __________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Professional Organizations: __________________________________________________________ ______________________________________________________________________________ Explain why you would like to serve on this committee: _______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Do you know of any potential conflicts: __________________________________________________ Return form to the Town Manager’s office at above address. Deadline- March 3, 2009
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