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2. Name:*
4. Address:*
6. Address Line 2:
8. City:*
10. State:*
12. Zip Code:*
14. Phone Number:*
16. Email Address:
18. Years as Resident:*
20. What Village committee(s) are you currently serving on, if any?*
22. If you are currently sitting on a committee, would you like to be reappointed?*

    1. Yes
    2. No
24. Committee/Board/Commission you are interested in:*

    1. Board of Trustees | Elected Official
    2. Historic Preservation Commission
    3. Montgomery Development Fund Committee
    4. Planning & Zoning Commission
    5. Beautification Committee
    6. Police & Fire Commission
    7. Police Pension Board
26. Why are you interested in serving on this particular board?*
28. Qualifications for serving on this committee:*
30. Other community involvement:*
32. Occupation/Employer:*
34. Leisure Activites/Hobbies:
36. Resume, Reference Letter, or Other Supporting Documentations
38. I certify that the above information is true to the best of my knowledge. I acknowledge that I am submitting the application by checking the yes box.*

    1. Yes
    2. No
40. Date:*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field