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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? )0 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 /> Applnt SignaturDate <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 /> Pequot Lakes,MN 56472 <br /> E-mail: cityhall@pequotlakes-mn.gov <br /> Website: www.pequotlakes-mn.gov <br /> This application will be kept on file for one year. oiler that Bine a neu application mast be filed. <br /> OFFICE USE ONLY <br /> The Applicant is: New Applicant _o pplying for Reappointment <br /> Council Action: Not Appointed <br /> Appointed to: P4 Z COP/0114- <br /> Date <br /> f /011/1-Date Appointed: I— 1 --7-007;2- <br /> Term <br /> z p7;2- <br /> Term Expires: /7 -�j9,'--2o2-11 <br /> S:Wdministration\City Clerk\Boards and Commissions\Application Process and Forms\Forms\Application Form for Boards and Commissions.doc <br /> Page 3 <br />