Town of Mina

Application of Interest

Thank you for showing support and interest in the Town of Mina.

The following information will be used to match your interest and expertise to the needs of the Town.

Please complete and mail or drop off at the Town Clerk's Office,

PO Box 38, 2883 North Road, Findley Lake, NY 14736

or fax to 716-768-7207.

Name_____________________________________________________________

Address___________________________________________________________

__________________________________________________________________

Home phone____________________________

Work phone (optional)____________________

E-mail_________________________________

Other contact information___________________________________

________________________________________________________

Please check the following areas of interest:

____Planning Board

____Zoning Board of Appeals

____Board of Assessment Review

____Recreation Committee

In regards to the above areas checked:

Will you commit to attend committee meetings on a regular basis? _________

Will you attend training sessions to keep abreast of current issues?_________

List at least two reasons you wish to serve on any of the boards/committees you checked.

1. ___________________________________________________________________________

2. ___________________________________________________________________________

Please list any skills that you would bring to the committees/boards you checked.

List the volunteer or paid involvement you have had with the Town of Mina in the past.

_________________________________                 _________________________
Signature                                                                                         Date