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* 1. Position for which you are applying:

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* 2. Please explain why you wish to serve in this position:

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* 3. Are you currently a member of another other organization's Board, Commission, or Advisory Committee?  Please specify.  

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* 4. Please describe any life or career experience that you feel will be helpful to this Board.

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* 5. Please indicate which of the following topics should be prioritized:

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* 6. Please print your name and sign:

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