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2. Please complete the online form below.
4. Personal Information
6. Select the Board, Commission, or Committee applying for:*
   -- Select One --Americans with Disabilities Act CommissionCharter Maintenance CommitteeCharter Review CommitteeCommunity Center Building CommitteeCommunity Preservation CommitteeConservation CommissionCouncil on Aging Board MemberCultural CouncilFinance CommitteeHistorical CommissionMemorial CommitteeOpen Space CommitteeRent Control BoardRockland Recreation BoardZoning Board of AppealsOther
8. Name:*
10. Home Address:*
12. Home Phone Number:
14. Business Address:
16. Business Phone Number:
18. Occupation:
20. Email Address:
22. Term of Appointment

    1. New
    2. Renewal
24. Residency Information
26. Length of Residency in Rockland:*
28. Are you a registered voter:*

    1. Yes
    2. No
30. Education and Hobbies
32. High School:
34. College:
36. Trade or Business School:
38. Hobbies:
40. Organization Membership Information
42. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
44. If yes, which:
46. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
48. If yes, which:
50. Please list organization memberships and positions held:
52. Please List Areas of Special Interest
54. Please Enter Basic Resume Information Below
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55. Submit

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