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HomeMy WebLinkAboutLeland City-County Health application • Print form ITO-El - E-mail form CITY OF BOZEMAN, MONTANA APPLICATION FOR THE CITY-COUNTY BOARD OF HEALTH Note: Joint Board -this application for City representative position only.Contact County Clerk for an application for other positions. Date:_W L-M/ / I Name: 9 Ap l b Physical Address: 5z 2q Al, Mailing Address (if different): Email: I p AAj c)n vt Q. , CQ yY1 Phone(s): EB-7 — 0 tp 1 i Z 20 - Length of time in the Bozeman area: Occupation: EI pcb2,LA_ co a:6= 1_ V fz_ Employer: So-( -f Have you ever served on a City or County board? (If so,where, what board, and how long?) -9 © q ± ID �eAe S Please explain your relevant qualifications, interests, and experiences. Lvt.eep-L k( Ziu r r4;�� )3 oAvz_D AdTw -r ov1 o(/ Ct �-n `f,;Zx Auer wit! ,9-��� 30Ap { o C S� r �f t�2.�a i�/c� c�.i ►�'c� i �(1�cQ'��To 2 �o�-rz� ,4��z.� o v� ��w►4-n-� So(v ec.� �,�-���a l�o �o% References (Individual or Organization)Name: Phone: S Mckl>_ eA EU d raj j 7 l/ i This application is considered public record. Application contact information may be displayed on the City of Bozeman website. PLEASE NOTE: Per Ordinance No. 1759, revising Chapter 2.01 of the Bozeman Municipal Code, all board members are required to attend a yearly ethics workshop provided free of charge by the City as a condition of service as a member of a board.