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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? x 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 /> (14.6.4 &`1-1- <br /> A ican 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 /> Pequot Lakes,MN 56472 <br /> E-mail:cityhall@pequotlakes-mn.gov <br /> Website:www.pequotlakes-mn.gov <br /> Tlri.c;rlry lic crliar frill b,,A(7'i ar/!I I(r OM r'ui: (r/rcv rhur MM.°(Ilk/r(1/)J)/ir00 011/1111.\1 b,'/Il<<l. <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:\Administration\Chy Clerk\Boards and Commissions\Application Process and Fonns\Forms\Application Form for Boards and Commissions.doo <br /> Page 3 <br />