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2. CURRENT MEMBER
4. Last name of Board Member
5. First name of Board Member
7. Mailing Address
9. City
10. State
11. Zip
13. Phone Number
14. E-mail
16. Board
17. Date of Term Expiration
19. Please mark your preferred method of contact:

    1. E-mail
    2. Phone
23. Board Member: Please check the following applicable boxes regarding your interest in serving another term on the Board.

    1. I AM interested in serving another term. (If marked, please complete box below)
    2. I am NOT interested in serving another term.
    3. I am interested in serving on a different board or committee of the City. (If this option is marked, please complete "New Member" application.)
25. Please list what expertise and/or capabilities you would bring to this board, committee, or task force:
27. THANK YOU FOR SERVING THE CITY OF EL DORADO!
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field