2. Contact Information
4. First Name*
5. Last Name*
7. Residence Address*
9. Mailing Address (if different from above)
11. Contact Number
12. Description

    1. Home

    1. Work

    1. Cell
14. Email Address
16. I Live:*

    1. Inside the Town of Cornelius
    2. Outside the Town of Cornelius
18. I Am Interested In Serving On The Following Board(s)

    1. Architectural Review Board
    2. Crime Initiative Committee
    3. Historic Preservation Committee
    4. Land Development Code Advisory Board
    5. Library Endowment Committee

    1. Parks & Recreation Commission
    2. Planning Board
    3. Transportation Advisory Board
    4. **Other
20. Please list qualifications or reasons you would like to serve.
22. Resume and/or Additional Information (*optional)
24. Date*
25. Signature*
27. Note:
    You may fax this form to the Town Clerk at 704-896-2462 or mail to PO Box 399, Cornelius, NC 28031
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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

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