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( ( . ( <br /> APPLICATION FOR APPOINTMENT TO Civic and Community Activities: Describe past or present civic and/or <br /> community activities that may be relevant in qualifying you to serve on this <br /> THE PEQUOT LAKES COMMUNITY LIBRARY BOARD board. <br /> a . CiAallo-QA-b-6cJ irs <br /> f- <br /> Name t f &n me eir■ 0 i-k- kly \_itoLicux) <br /> 9 k>or\d,c),.\ so,,ot7t, ---cefx_cif <br /> 'AA/ Sc14 <br /> Permanent resident ✓ yes no <br /> Permanent address p 1( 3(O1 Ti he l Velr MN 5 -17 , . <br /> Secondary address Attendance: The Library Board meets on the third Thursday of each month. <br /> It is important that you attend regularly and participate in other activities of <br /> the Library (fundraising, helping with special events, working a Thursday <br /> 40,,,....,,c)a <br /> Phone .- , 40,,,....,,c) me work evening (4 — 8 p.m.) shift at the Library, if possible, on occasion. Do you <br /> feel you have the time available to be an active participant? <br /> 1. - <br /> yes no <br /> Occupation ' <br /> MTcuj <br /> Comments: <br /> Employer <br /> How long have you lived in the area ` 2,- <br /> Conflict of interest: I wish to disclose the following potential conflicts of <br /> interest that may or will arise if I become a member of the Library Board. <br /> Statement of Interest: Please explain why you would like to serve (or a. 0.01#6 • w ' • hru , rt <br /> continue to serve) on the Libr Board. 4v V <br /> iNslAcs ., b • 4 : 0,,r\(L. <br /> ,.. ..wks.x.k.0 $4 I A ip: Mli t )k 1 I 0 A I <br /> iNiiitsve. <br /> ALCLCIAll CitAle1410 Ckia:)..t.)1, <br /> Educational and Professional Experience: Describe your educational and ., <br /> professional experience or skills that qualify you to serve on this board. . . I 5/2z/O e <br /> 5S131-Cik) QVA‘k),),:cidi0 ''') q ,,, <br /> Si: :ture \ Date <br />