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2. Select the Board, Commission, or Committee applying for*
   -- Select One --Select OneAg Advisory Land Use Airport CommissionBoard of CanvassersBuilding AuthorityCommunity Corrections Advisory BoardCommunity Mental HealthCounty Planning CommissionDepartment of Human ServicesDepartment on Aging Economic Development Corp.Emergency 911 DistrictHealth BoardLand Bank AuthorityLenawee District LibraryLenawee TransportationLocal Emergency PlanningParks & Recreation CommissionRegion 2 Area Agency on AgingRegion 2 PlanningRemonumentation Peer GroupSolid Waste Coordinating

   Which board vacancy are you interested in?

4. Personal Information
6. First Name*
7. Last Name*
9. Sex:

   1. Male
   2. Female
11. Address1*
13. City*
14. State*
15. Zip*
17. Phone Number*
18. Alt Phone Number
19. Email Address*
23. Occupation*
27. Residency Information
29. Length of Residency in Lenawee County*
30. Are you a registered voter*

    1. Yes
    2. No
32. Education and Hobbies
34. College/Trade/Business School
    Please share your educational background
36. Clubs/Volunteer Positions/Special Interest
38. Organization Membership Information
40. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
42. If yes, please provide the names of the boards, commissions, or committees
44. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
46. If yes, please provide the names of the boards, commissions, or committees
48. Please list organization memberships and positions held
50. Please List Areas of Special Interest
52. Please Enter Basic Resume Information Below
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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

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