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Application for Appointment to City Board/Commission/Committee

2. Full Name*

4. Street Address*

6. Mailing Address (if different than street address)

8. Phone Number (daytime)*

9. Phone Number (evening)*

11. Email Address*

13. Length of Time as a Lewiston Resident*

14. Council Ward*

16. I wish to be appointed to:*

18. Check one or both

    1. Full Membership Status

    1. Associate Member Status

20. Please list any related experience, knowledge, education, skills, or abilities that you feel would make you a good fit for this Board/Commission/Committee:

22. Date*
    Date

23. Electronic Signature*

25. <i>Thank you for your interest in serving the City of Lewiston.</i>

    Thank you for your interest in serving the City of Lewiston.

Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field