APPLICATION FOR APPOINTMENT
TO CITY COMMISSION/COMMITTEE

Name:  __________________________________________________

Home Address:  ___________________________________________

Home Phone:  _________________Work Phone:  _________________

Occupation:  ______________________________________________

Indicate the Commission/Committee (if any) on which you currently serve:

 ________________________________________________________

________________________________________________________

List Commission/Committee Preferences:

1. ___________________________________________________
   
   

2. ___________________________________________________
   
   

3. ___________________________________________________
   

Describe Past Community Activities:  __________________________

_______________________________________________________

_______________________________________________________

Date:  ______________   Signature:____________________________

Deliver to:  1245 N. Hacienda Road, La Habra Heights, CA 90631

FAX to:      (562) 694-4410