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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. Reply Email*
27. Thank you for your interest in serving the City of Lewiston.
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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