HomeMy WebLinkAbout1989-07-18; City Council; 10148; APPOINTMENTS TO THE CARLSBAD ARTS COMMISSIONb
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,i" 4 CITWF CARLSBAD - AGENDWILL ._
AB# /<~/#f TITLE: DEPT
APPOINTMENT TO THE CARLSBAD CITY, MTG. 7/1aia9
CITY DEPT.cc ARTS COMMISSION
RECOMMENDED ACTION:
Adopt Resolution No. Commission. f,%Jf/, appointing one member to the Carlsb;
ITEM EXPLANATION
Dr. Thomas Brierly has resigned as a member of the Carlsbad Arts Commissio vacated term does not expire until March, 1990; therefore, it is recommend
Mayor appoint a member to fill the unexpired term.
A Notice Inviting Applications was advertised in the Carlsbad Journal and th Tribune, on Friday, June 30, 1989.
Other members of the Commission are: Joe Bear, Wayne Bischoff, Stanley Jers Ladouceur, Donna Meilach, and Patra Straub.
Copies of applications received in calendar year 1989 are attached for review.
EXHIBITS
1. Resolution No. f7-25/ , appointing one member to the Carlsbac
2. Letter of resignation from Dr. Brierly dated June 12, 1989.
3. Copies of applications received in calendar year 1989.
Commission.
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RESOLUTION NO. 89-251
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, APPOINTING ONE MEMBER TO THE CARLSBAD ARTS COMMISSION.
WHEREAS, Dr. Thomas Brierley has resigned as a member of the Carlsl
Commission from a term expiring in March, 1990;
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of C<
California, as follows:
1. That the above recitations are true and correct.
2. That the following person is hereby appointed to serve as a mc
the Carlsbad Arts Commission for a term expiring in March, 1990.
Kim Mikhael
PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Cot
the City of Carlsbad on the 25th day of July , 1989, by the fc
vote, to wit:
AYES: Council Members Lewis, Kulchin, Pettine, Mamaux and Larson
NOES: None
ABSENT: None
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MAUDE A: LEWI6, 'Flayor I
ATTEST:
ALETHA bx! L. RnuTENK$w\
(SEAL)
e
Mailing Address. 801 Pine Avenue, Carlsbad, California 92008-2439
BOARD OF TRUSTEES
J. EDWARD SWITZER, JR.
President
DONALD M. JOHNSON
Vice President
JOE ANGEL June 12, 1989
Clerk
JAMES McCORMICK
Member
JULIANNE L. NYGAARD The Honorable C1 aude A. ”Bud” Lewis
1200 Elm Avenue Member filayw, C i tj of Cai-i sbad
DISTRICT Carlsbad, CA 92008
THOMAS E. BRIERLEY, Ed.D. Dear Mayor Lewis:
Please accept this as my letter of resignation from t
Assistant Supenntendent Carlsbad Arts Commission. I have enjoyed working with t
Instructional Services other Commissioners for the last three years and have learned
It has been a challenge to attend the meetings and match
GERALD C . TARMAN calendar and responsibilities with those of my fell
Assistant Supenntendent Commissioners who also lead very busy productive lives. T other Commissioners have been most generous in adjusting the
CHERYL ERNST daily demands to my schedule. Even then, I have often fou myself unable to attend the scheduled meeting.
DEWAYNE L. FUSEL Much of what the Commission initially started out to do h It is probably time for anoth Facilit~es/Maintenance/ been accompl i shed.
Thank you again for the opportunity to serve, and I wish t
Arts C~n;zissior: great scccess.
ADMIXISTRATION
Supenntendent
SUSAN-HARUMI BENTLEY, Ed.D
JOHN H. BLAIR
Assistant Supenntendent
Business Servlces
Personnel Semces
Director
Elementary Education
Manager
Operations
Thomas K. Brierley, Ed.D. District Superintendent
Distinguished School Board Award 1984, United States Department of Education
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TELE (619) 4
1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
Office of the City Clerk Uitp of (anrlstrab
APPLICATION FOR APPOINTMENT
BOARD(S1 AND/OR COMMISSION(S) G 3
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(Please print or type.) .=."k
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NAME(S) OF BOARD(S) AND/OR COMISSION(S) IN WHICH INTERESTED:
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NAME: Theodore R. Frye
ADDRESS : 71 21, T.-L
CITY: Carlsbad- ZIP CODE: 92009
HOME PHONE: 118 ?765
PRESENT OCCUPATION: Retired.
BUSINESS NAME:
BUSINESS ADDRESS:
WORK PHONE:
U.S. Citizenship (required for all appointments) y Yes
Resident of Carl sbad (preference given to residents) v Yes
Registered voter in Carlsbad (required for some commissions) X Yes
I am familiar with the responsibilities assigned to the Board(s) or Commission(s) I wish to serve; I am willing to provide required statements if appointed to a Board or Commissior to f i nanci a1 disclosure; I am willing to be interviewed regarding my qualifications for appointment by a ( designated by the City Council or at the request of an individual Council Memt
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SIGNATURE: DATE: /- qd--cf 5
(Continued on reverse side.)
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EDUCATION
B.A., Oberlin College
M.B.A., New York University
EXPERIENCE
15 years in U.S. Foreign Servicct
20 years, Treasurer, Rockefgller Foundation
COmtlNITY ACTIVITIES
Tutor in Carlsbad Adult ‘Learning Program
ADDITIONAL INFORMATION OR COmENTS
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1200 ELM AVENUE
CARLSBAO, CALIFORNIA 92008
Office ot the City Chd attg af &Irisbail 38
APPLICATION FOR APPOINTMENT *is 82
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NAME:
ADDRESS:
CITY:
ME PHONE:
PRESENT OCCUPATION:
BUSINESS ME:
BUSINESS AOORESS:
WORK PHONE:
U.S. Citizenship (required for all appointments)
Resident of Carlsbad (preference given to residents)
Registered voter in Carlsbad (required for some connissions)
- J Yes
- I,- J Yes / Yes
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(s) or Conmission(
ked statements if appointed to a Board or CoRlRiss
ing ray qualifications for appointllent by t at the request of an individual Council Mc
DATE: ,?ll-P/
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CAALSBAO, CALIFORNIA 92008
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Office of the City Clerk
APPLICATION FOR APPOIN TMENT
BOAR D(S) AND/OR COMMISSION (9
(Please print or type.)
WE(S) OF BoARD(S) AND/OR C(MISSION(S) IN WHICH INTERESTED: &&d 74% &flm;55/--
NAME : Mar&& /@-e
ADDRESS : %56 ,D m& &/&
HOME PHONE: 61% qyz/ I +Y--s CITY: ZIP CODE: -7A
PRESENT OCCUPATION: -
BUSINESS NAME:
BUSINESS ADDRESS:
WORK PHONE:
U.S. Citizenship (required for all appointments)
Resident of Carl sbad (preference given to residents)
Registered voter in Carlsbad (required for some commissions)
I am familiar with the responsibilities assigned to the Board(s) or Comnission(s I wish to serve; I am willing to provide required statements if appointed to a Board or Comnissii to f i nanci a1 disc1 osure; I am willing to be interviewed regarding my qualifications for appointment by a designated by the City Council or at the request of an individual Council Me1
SIGNATURE: *A& DATE: @h;
(Continued on reverse side.)
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1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
Office of the City Clerk
APPLICATION FOR APPOINTMENT
BOARD (SI AND/OR COMMISSION ($1
(Please print or type.) e --
NAME~) OF BOARD(~~ AND/OR COMISSIO~(S) IN WHICH INTERESTED:
CARLSBBD- ARTS CO?HM-ISSIQN-
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. MAEty bl. SKINNER (Mrs. William P. Skinner)
ADDRESS : 3065 Ocean Street
CITY: ZIP CODE: 920( Carlsbad
+.I . .
PRESENT OCCUPATI
BUSINESS ADDRESS : % c.’
U.S. Citizenship (required for all appointments) X Yes
Resident of Carl sbad (preference given to residents) X Yes
Yes Regi stered voter k Carkbad- (Fauir
E am- famiJiar
-- - fm some CoTi > ,- *-I, --- 6
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oniiM1 ities assi d ’to the ’ bard (s) or ,Comi ss i on (s
statements‘ if- appointed’to a, Board or €omissic
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EDUCATION
B.A. Pomoria College, Claremont CA
M.A. (musk) Columbia University, New York
EXPERIENCE #ember/mursic faculty DePauw University, Greencastle Indian; Member/music faculty Clnapman College, Los Angeles (before I
Executive Secretary and Assistant to the Directsr/Thorne Hi
Field Secretary for California Assemblyman FranR Lanterman
Field Representative for US Congressman H. Allen Smith (nor Executive Secretary Pagadena Beautiful Foundation
campus oras moved to Orange County)
Occidental College (in charge of concert series)
deceased )
J. C-ITY ACTIVITIES
Member/Housing Advisory and Appeals Board, City of Pasadenz (duties included monthly meetings with jurisdiction on hc
Member/ Board of Directors Pasadena Symphony Association (5 Program Arvlotatsr/Pasadena Symphony Association (4 yrs) President/’Pasadena Symphony Association (3 yrs) Member/Pamadena Arts Counci:L (3 yrs) Member/Boawd of Directors Young Musicians Foundation, Los P
zoninw’use violations relative to City municipal code)
(2 yrs)
ADDITIONAL INFORRATION OR COmENTS
Cornunity involvement and active participation in a variety activities have always been part of my life here in Pasader
While we have yet to be ful:L time residents of Carlsbad, I continued to follow the local news through a subscription t Journal. Now that we will 1x3 making Canlsbad our home, I B enjoy being a part of its community life and hopefully brir it some of the experiences :I: have had. The fact that the C of Carlsbad recognizes that promotian of the arts as bringi benefits and advantages to all concerned is more than corma~ it is quite unusual1 Pasadena just got around to creating own Arts Commission onlly this past yeart!
.
3.
106 Club Road
Pasadena, CaliIornia 9 1 105
ADDENDUM;
We have owned our home on Ocean Street since 1962. During the tlgrowing-upt* years we were there every summer and all other vacation times. I I 1 The family participated in surfing contests,
1 library reading programs, attended summer school, 1
I worked for the State Parks Dept, waited tables
and in general did what all kids do.
Later,the house was mostly rented until now when we have been undergoing our remodeling program. That work should be completed by April sometime and we would be moving in May.
Until then, 3: cannot correctly say that we are "residents" of Carlsbad, noR are we registered voters, noK do we have a phone number. (The old one has probably been discontinued.)
But - we will be!
I
$4 .s
Feb. 15/89
(213) 681-9454
(818) 792-8221
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TELE 1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008 (619)
Offrce of the City Clerk CD 2 $23 -tc 4c t-
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BOARD 6) AND/OR COMMISSION (SI
APPLICATION FOR APPOINTMENT %I
NAME(S) OF BOARO(S) AND/OR COmISSION(S) IN WHICH INTERESTED:
P3-nLSLWn Rfl7-5 CaWi5;ad
NAME: OwuPIz T. 4flTTEK
ADDRESS : 9/a-E C&f?l/ N/n B-iADtWbAL-
CITY: CARLAB8 D ZIP CODE: %?-L
HOME PHONE:
PRESENT OCCUPATION: Zfl ;b-rCfl~l'h'Dn/ - S c%? /-k' 5 %KY? d U tfa th f
6 I9 - 5'38- 93Oq
BUSINESS NAME: -&e -h, mu 'O/ flStuuChL7'f)Q oF*r-
BUSINESS ADDRESS: fi.0 uup-?&v~f borqt OLA~ U WORK PHONE:
U.S. Citizenship (required for all appointments)
Resident of Carl sbad (preference given to residents)
Registered voter in Carlsbad (required for some commissions)
I am familiar with the responsibilities assigned to the Board(s) or Commission(s) I wish to serve; I am willing to provide required statements if appointed to a Board or Commissio to f i nanci a1 di scl osure; I am willing to be interviewed regarding my qualifications for appointment by a designated by the City Council or at the request of an individual Council Mea
J Yes -7 Yes - /Yes
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DATE: w SIGNATURE: dh cw
(Continued on reverse side.)
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EDUCATION
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LAURIE J. EATTEE
Carlsbad, CA 32@09
! 613) 438-92.04
912-B Caminito Madrisal
A proven sales and marketing professional with more than 10 years
of experience at setting goals, arid surpassing them.
Feb. 1982 - June 1989
Eight years of increased responsibilities in customer relations
and sales administration. Demonstrated performance in key accoun
management. program development. motivation. training.
-_.__ __--^_ -_----- --- - ALOPEX INDUS-T-~I.E_S-JNC. , San Marcos. CA.
. Manager of Customer Relations 1988 - 1989 . Manager of Sales Administration 1986 - 1988 . Assistant to Vice President-Sales 1982 - 1986
x Created and managed outbound dealer telemarketing department.
Development of all goals. quotas, scripts, systems, training. - Achieved 50% contact to sales presentation ratio, with 12%
program commitment.
* Developed International Market, participated in international
shows. conducted training seminars, coordinated all orders.
- Increased sales by 22%.
* Managed Order Entrv Department. including all special sales
promotions, upsell/cross-sell program. - Processed in excess of $30 mil in orders annually.
Average upsell/cross-sell S%/year.
X OEM key account management, developed existing and new accounts,
custom requirements. quality assurance, pricing recommendations. - Average annual key account order $150.000/~ear.
* Recommended and implemented policy/procedures relating to customej
Pricing, gross margins. credit considerations. promotions, and
where required. complete product phase out.
- Sold entire inventory of product phase out in one week.
- Identified buyer for product line and assisted in transition.
* Developed and implemented sales management analysis and reporting
systems: dealer profiles, call books. monthly sales tracking,
new product activity. feedback reporting.
e e
* Wrote key marketing/sales communications including customer bul
training materials. sales manuals. planning guides, trade artic
* Administered Marketing, Advertising and Sales programs and
budgets, including co-op advertising ($500.(300 budget). direct
instore dealer promotions, distributor open houses.
* Planned and coordinated national and regional sales meetings anc
trade shows. Participated in annual incentive convention.
* Hired. trained, supervised and motivated staff.
BATTER --- OFFICE PRODUCTS. Vista, CA. Au~. 1978 - Au~. 1980 SALES MANAGER. FIELD SALES
* Generated 40% increase in sales.
* Managed 150 accounts; supervised two people.
* Implemented sales management system, developed market
segmentation selling strategy.
YMCA/CAMPUS BRANCH . Cleveland. OH. AuE. 1-975 - July 1978 OFFICE MANAGER
* Budget projections, fund raising, published monthly newsletter, maintained mail list, assisted Board of Directors.
E DUCATJaN
- Case Western Reserve University, Cleveland, Ohio,
B. A. Cum Laude.
- Certified, Management Action Program (MAP), Newport Beach, CA
- Certified Trainer. GTE Telemarketing. Train the Trainer,
Sales/Telemarketing.
- French Fluency.
PROFESSIONAL AFFILIATIONS
- American Telemarketing Association.
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RECEf VEQ TE '"' Ck%Rfi'S ffFF@ (611 1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008
8UUL 13 WH $: 11
situ uf (Ilnrlsbnh CITY OF GAWCSB&j
Offlce of fhe C~fy Clerk
APPLICATION FOR APPOINTMENT
BOARD ($1 AND/OR COMMISSION ($1
(PTease print or type.)
NAME(S) OF BOARD(S) AND/OR CWISSION(S) IN YHICH INTERESTED:
CasIsbad ,A 4.S c6 mmLs S/O?
NAME: .- nn A. L't/eu v-eu~
ADDRESS : 173/ d/Lt vo eouvt"
PRESENT OCCUPATION: ome maker
CITY: fla)-(ILGd ZIP CODE: 4;
HOME PHONE: 734 - 700 5
BUSINESS NAME:
BUSINESS ADDRESS:
WORK PHONE:
U.S. Citizenship (required for all appointments) X Yes
Resident of Carl sbad (preference given to residents) 6 Yes
Registered voter in Carlsbad (required for some comnissions) - X Yes
I am familiar with the responsibilities assigned to the Board(s) or Commission( I wish to serve; I am willing to provide required statements if appointed to a 8oard or Commiss to financial disclosure; I am willing to be interviewed regarding my qualifications for appointment by designated by the City Council or at the request of an individual Council M
DATE: 7-12 I S I GNATURE :
(Continued on reverse side.)
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1200 ELM AVENUE RECEi'be"; TELE
CARLSBAD, CALIFORNIA 92008 CITY CtEESi;'S (JP"TiCE (619)
Offce of the City Clerk E.M. 18 pf? /:OT
(Ititg af (aarlsb*y GF CptsEW3
APPLICATION FOR APPOINTMENT
BOARD ($1 AND/OR COMMISSION ($1
(Please print or type.)
NAME(S) OF BOARD(S) AND/OR COmISSION(S) IN YHICH INTERESTED:
CARLSBAD ARTS COMMISSION
NAME: Dawn Larsen
ADDRESS : 6839 Alderwood Drive
CITY: Carlsbad ZIP CODE: 9200
HOME PHONE: 931-940 1
PRESENT OCCUPATION: Director of Resident Relations (Retirement Facility)
BUSINESS NAME: Casa de las Campanas
BUSINESS ADDRESS: 18655 West Bernard0 Drive, San Diego, California 92127
WORK PHONE: 451-9152 Ext. 812
U.S. Citizenship (required for all appointments) - Yes
Resident of Carl sbad (preference given to residents) - Yes
Registered voter in Carlsbad (required for some commissions) - Yes
I am familiar with the responsibilities assigned to the Board(s) or Commission(s) I wish to serve; I am willing to provide required statements if appointed to a Board or Commissic to financial disclosure; I am willing to be interviewed regarding my qualifications for appointment by a designated by the City Council or at the request of an individual Council Mem
SIGNATURE : DATE: 11 July 89
(Continued on reverse side.)
W lw
E WCAT I ON See attached resume
EXPERIENCE
See attached resume
Additional Information:
Responsihle for the creation of a Senior Citizen Art Gallery in two
retirement communities. Helped develop a Senior Art Appreciation
Program and a program in a local elementary school.
CWNITY ACTIVITIES
ADDITIONAL INFORMATION OR COmEMS
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DAWN LARSEN
936 Hawthorne
Carlsbad, California 92008
(619-931-9401) -
EXPERIENCE:
Activities Director
Wesley Palms 2404 Loring San Diego, C alifornia 1987-Present
Scheduling and implementation of daily social, educational,
and physical activities for retirement facility of 315 res-
idents, coordinate management training and inservice instru
tion of management staff, plan and facilitate major marketi
events.
Educational Proqram Coordinator
Senior Center 24350 Civic Center Drive
1985-1987 Southfield, Michigan
Faculty Supervisor, design and schedule educational program
organize and facilitate faculty meetings, open house, stude
faculty events, responsible for design and distribution of
class brochure, set up and facilitate workshops, coordinate
class registration, supervision of volunteer program.
Adult Education Instructor
West Bloomfield Adult Education 5475 Maple Road
1984-1987 West Bloomfield, Michigan
Farmington Community Center 24705 Farmington R9ad
1984-1987 Farmirigton Hills, Michigan
Franklin Club Apartments 28301 Franklin Road
1983-1987 Southfield, Michigan
Southfield Senior Adult Center 24350 Civic Center Drive
1984-1987 Southfield, Michigan
La Vida Del Mar 850 Del Mar Downs Road
1987-present Solana Beach, California
Present slide lectures on educational and culturally enrich
topics, develop curriculum, photograph and research materia
arrange educational field trips to museums and galleries.
Facilitator of Self Awareness Geriatric Proaram
Cambridge Nursing Care West Facility - Beech Dall
1983 Redford, Michigan
Bloomfield Hills Care Center 50 W. Square Lake Road
1983 Bloomfield Hills, Michigan
Created and implemented program combining art enrichment
with self-awareness for residents in nursing care facilitif
e 0
Page two
Coordinator of Art ADDreciation Proaram
Walled Lake School System
1978-1984 Union Lake, Michigan
Established and participated in a program introducing visual
to elementary school children,
Smithsonian Archives of American Art
Detroit Institute of Art, 1982
Organized and prepared material acquired from artists to be
put on microfilm.
Keith Road
advisor for volunteers.
Intern for Smithsonian
EDUCATION:
Oakland University B.A. Art History Rochester, Michigan
Skyline College A.A. Liberal- Arts
San Bruno, California 1977, With Honors, Dean's List
1982, Magna Cum Laude
PROFESSIONAL ORGANIZATIONS:
North County Activity
Professionals' Organization
May 1987-1988
Executive Board Recording Secreta]
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1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008 (6
Office of the City Clerk
aitg of (anrlsbn2l
BOARD ($1 AND/OR COMMISSION ($1 52 SA 2& (Please print or type.) a r-
APPLICATION FOR APPOINTMENT
a
7- c3w * ;P a II-X
:b
NAME(S) OF BOARD(S) AND/OR CCrmISSIcuC(S) IN YHICH INTERESTED:
Arts Commission
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NAME: RnhLn;lnn
ADDRESS : 1535 Sunrise Circle
CITY: Carlsbad. CA ZIP CODE: 92
HOME PHONE: 619-434-2291
PRESENT OCCUPATION:
BUSINESS NAME:
-iitive vice - Prpqident
BUSINESS ADDRESS: 5411 Avenida Encinas, Ste. 100
WORK PHONE: 619-931-8400
U.S. Citizenship (required for all appointments) R Yes
Resident of Carlsbad (preference given to residents) X Yes
Registered voter in Carlsbad (required for some comnissions) x Yes
I am familiar with the responsibilities assigned to the Board(s) or Commission
I am willing to provide required statements if appointed to a Board or Commis
I am willing to be interviewed regarding my qualifications for appointment by
I wish to serve;
to financial disclosure;
il or at the request of an individual Council
DATE: 7/13/89
(Continued on reverse side.)
w w
EDUCATION
Liberal Arts, University of Wisconsin-Milwaukee
Institute for Organizational Management, University of Colorado, Boulder
EXPERI ENCC
1976-79 - Member/Chairperson, Fine Arts Committee, University of Wisc-Washington
1980 - Developed Community Program for Businesses and Residents for support for t
1977-1954 - Performer and Managing Assistant in the University Theatre Program
1981-56 - Member/Soloist Moraine Area Chorus
1983-84 - Developed Business Support Program for the Community Art Gallery
University Repertory Theatre
' Principal roles in "Godspell", "Fiddler on the Roof", "Pippin",
!XWUNITY ACTIVITIES
1987 - Docent, LaPurisrna Mission State Park (served as guide and resource to tour
1988 - Present - Membei-/Soloist, Choir, Beautiful Saviour Church, Carlsbad
1988 - Season Ticket Holder, San Diego Ballet
1986 - worked with Victoria FIamilton in Santa Barbara County for a coalition for
groups at this historic state park)
Arts and Tourism. --
As the public relations director for a campus of the University of Wisconsin, I
brought Art Exhibits, performances (including the Tational Theatre for the Deaf),
well as grants from the National Endowment for the Arts.
As a Chamber of Commerce Executive in three cities, I have encouraged the Busines
Community's support for cultural arts activities.
9 ;EL 1200 ELM AVENUE
CARLSBAD, CALIFORNIA 92008 (6 19)
Office of the Oty Clerk
e ?YJ@ - u ’- (/ c/
Caitg of (anrls bnb
APPLICATION FOR APPOINTMENT
BOARD ($1 AND/OR COMMISS ION (SI - 0% 2& (Please print or type.) QPq 7-F LT 4:- i b 27 3h 6 - c 1- tz ?.”#
2b - Y woff
I -. .,. NAnE(S) OF BOARD(S) AND/OR COmISSION(S) IN WHICH INTERESTED:
- 5 &mis.5,hc) r\l
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NAME: )+-&#fl5 L
ADORES : 270 I 64 .\ IAAl\l f +A
CITY: (AR LSMh ZIP COOE: %
HOME PHONE: 724%184
PRESENT OCCUPATION:
BUSINESS NAME: - C&ISa& 3&&4 <LC33 L
BUSINESS ADDRESS: S% Gl%+.I i\ C*5*n
I %I=? -Emb4.& /a== \L
WORK PHONE: 4%Cc90 / 729004.T
U.S. Citizenship (required for all appointments)
Resident of Carl sbad (preference given to residents)
Registered voter in Carl sbad (required for some comni ssions)
I am familiar with the responsibilities assigned to the Board(s) or Comnission( I wish to serve; I am willing to provide required statements if appointed to a Board or Comniss to financial disclosure; I am willing to be interviewed regarding my qualifications for appointment by designated by the City Council or at the request of an individual Council M
- / Yes
I/ Yes
I/ Yes
+ S I GNATURE : DATE:
(Continued on reverse side.)
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