Name* (First and Last)
Date* (ex: 01/30/2017)
Address*
Email Address *
Telephone Number*
Area Code and Number, ex. (209) XXX-XXXX.
Cell Phone Number*
Please indicate the Commission/Committee for which you wish to apply (select one):*
Select OnePlanning CommissionParks & Recreation CommissionAirport CommissionTree CommissionMeasure P CommitteeMeasure H Citizens Oversight CommitteeEconomic Development Advisory Commission (EDAC)
How long have you resided in the City of Los Banos?*
Are you registered to vote in the County of Merced?*
Would you be available for meetings in the daytime/evenings/or both?*
Why are you interested in serving on this commission/committee?*
List education, training, or special knowledge which might be relevant to this appointment*
Please indicate any further information that will be of value regarding your appointment*
For verification purposes, please type in the text you see below:
