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2. Your Full Name*
3. Your E-mail Address
5. Your Current Mailing Address*
7. City
8. State
9. Zip Code
11. Is your current mailing address different from your current street address?*

    1. Yes
    2. No
12. Your Current Street Address (different from mailing)
14. Your Phone Number*
15. Alternate Phone Number
17. How Long Have You Been a Waterville Resident?
18. Your Occupation
20. Please indicate which Board(s)/Committee(s) you would like to be a member of

    1. Any Committee
    2. Board of Assessment Review
    3. Board of Zoning Appeals
    4. Comprehensive Plan Review Commission
    5. Ethics Committee
    6. Fair Hearing Authority
    7. Fire/EMS Advisory Committee
    8. Haines Charity
    9. Historic Preservation Commission

    1. Kennebec Sanitary Treatment District Trustees
    2. Kennebec Water District
    3. Parks & Recreation Committee
    4. Planning Board
    5. Public Library Trustees
    6. Rent Stabilization Board
    7. Voter Registration Appeals Board
    8. Waterville Housing Authority Commissioners
    9. Waterville Sewerage District Commissioners
22. Do you have any relationship with the mobile home park owner and/or mobile home park employees OR any relationship with a former or current mobile home park lot renter? *

    1. Yes
    2. No
24. If yes, please provide specifics on the relationship.*
26. Are you currently employed (full-time or part-time) by the City?

    1. Yes
    2. No
28. Please state why you wish to serve on a board/committee:*
30. Please list your interests/skills that would benefit the board(s)/committee(s) you indicated:*
32. Please list one reference*
33. Please enter a phone number for your reference*
35. By typing your full name below you are signing this document and verifying all information entered is true*
36. Date Signed
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field