Parks and Recreation Advisory Board

Your title*
—Please choose an option—Mr.Mrs.Ms.Dr.

Your first name*

Your middle initial*

Your last name*

Your address*

Your email address*

Your phone number*

Your highest level of education*

—Please choose an option—High SchoolGEDAssociates degreeBachelors degreeMasters degree

Date of Graduation*

Degree(s) Received*

Major(s)*

Work Experience*

Field(s) of Employment*

Current or Last Employer*

Job Title*

Other experience/interest relevant to parks and recreation*

Qualifications*

Please list the names of all civic organizations in which you currently hold membership and your position within the organization*

Are you aware of any potential conflicts of interest that may arise during your service on this board (i.e., property interest, business interest, etc.)? If so, please explain: *Potential conflicts of interest do not preclude appointments*

Based on your qualifications and experiences, briefly describe why your service on the board/commission of interest would be beneficial to the City of Locust:*

Communication Preference*
I prefer email communication.I prefer a phone call for communication.I prefer text message for communication.