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2. Select the Board, Commission, or Committee applying for*
   -- Select One --Board of AdjustmentsUrban Deer Advisory GroupAnimal Shelter Advisory BoardCarbon County Airport BoardCarbon County Visitor's CouncilFire Civil Service CommissionRR Golf Course Advisory BoardDDA/Main StreetOld Pen Joint Powers BoardParks & Recreation Advisory CommitteePlanning CommisionPolice Civil Service CommissionRawlins Community Shooting Range Advisory BoardUrban Systems Commission
4. Contact Information
6. First Name*
7. Last Name*
9. How do you pronounce your name? This will help council say in correctly during a motion to appoint.
11. Address1*
13. Address2
15. City*
16. State*
17. Zip*
19. Email Address
21. Contact Phone Number*
23. Residency Information
25. How long have you lived in Rawlins?*
27. Are you a registered voter*

    1. Yes
    2. No
29. Education, Experience and Hobbies
31. What knowledge, skills and experience will you bring to the Board/Commission/Committee you are applying for?
33. Occupation, Profession or Position*
35. Please tell us about your work experience. *
37. Please tell us about your education.
39. Please tell us about your interests. *
41. Organization Membership Information
43. Please list any current or past experience on City Boards, Commissions, or other City volunteer opportunities, as well as any offices held:
45. Please list current activities or volunteer work (i.e., involvement in the areas of Health, Social Services, Education, Recreation, Youth, Aging, Government, Community Relations, Art, History, Agricultures, etc.):*
47. Do you have a unique perspective regarding issues facing the board(s)?*
49. Please list, if applicable, any curcumstances that may restrict your availablity to serve. Please also feel free to use this space to provide us any additional information. Thank you!
51. Please feel free to provide us with any additional information you believe would assist us in our appointment process. Use additional sheets if necessary. Letters of recommendation are welcome but certainly not a requirement.
53. I certify that all information contained on this application is true and complete to the best of my knowledge and belief. I understand that any misrepresentations or falsifications may result in removal of appointment.
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55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field