Dutchess County Tick Task Force Question Title * 1. Your name (Required.) Question Title * 2. What's the best email to reach you? (Required.) Question Title * 3. What is your home address? (Required.) Question Title * 4. What is the best phone number to reach you? (Required.) Question Title * 5. Why are you interested in serving on the Tick Task Force? (Required.) Question Title * 6. What do you hope this task force will accomplish? (Required.) Question Title * 7. Do you have experience in any of the following fields/industries? Select all that apply. (Required.) Agriculture Community Outreach Education Emergency Services Environmental Conservation Forestry Healthcare Landscaping Municipal Government Nonprofit Leadership Parks & Recreation Pest Management Public Health Scientific Research Veterinary Medicine Volunteer Coordination Other (please specify) None of the above. Question Title * 8. Please describe any education, professional experience, volunteer work or other experience relevant to tick awareness, Lyme disease or tick-borne illnesses. (Required.) Question Title * 9. Have you or a member of your household been affected by a tick-borne illness? (Required.) Yes No Prefer not to answer. Question Title * 10. Are you able to attend regular meetings? Yes No Question Title * 11. Do you have any affiliations that could present a conflict of interest regarding recommendations made by this task force? (Required.) Yes No Question Title * 12. Are you currently serving on any other municipal boards, committees or commissions? (Required.) Yes No Question Title * 13. Is there anything else we should know when considering your application? Done