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Attendance: Are you aware of the importance of regular meeting attendance including <br /> the time commitment involved in preparing for meetings and do you feel you have the <br /> time available to be an active participant?�_Yes No <br /> Comments: <br /> Conflict of Interest is defined as the participation in any activity,recommended action, <br /> or decision from which the individual has or could have the potential to receive personal <br /> gain, whether it is direct or indirect. In accordance with this definition, do you have any <br /> legal or equitable interest in any business which could be construed as a conflict of <br /> interest? � Yes �No <br /> If yes,provide details on a separate piece of paper. <br /> 3.�;,,ti� Z a Z-b <br /> Applicant Signature Date <br /> Questions may be directed to the City Administration Office at 218-568-5222. _ <br /> Return Completed Application to: City of Pequot Lakes <br /> City Administrator <br /> 4638 Main Street <br /> Peyuot Lakes, MN.56472 <br /> E-mail: nmalecha(a�peyuotlakes-mn.�ov_ <br /> Website: www.pequotlakes-mn. o�v <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant Applying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to• <br /> Date Appointed• <br /> Term Expires: • <br /> S:Wdministrarion\City C1erk�Boards and CommissionsWpplication Process and Forms�Fomis�,4pplication Forni for Boazds and Commissions.dce <br /> Page 3 <br />