2. 
4. Name:*
6. Address:*
8. City:*
9. State:*
10. Zip:*
12. Phone Number:*
13. Email Address:*
15. Are you currently a resident of the City of Bismarck*
    -- Select One --YesNo
17. Please explain your reasons for wanting to serve on this board, commission, or committee:*
19. Please include your education or certifications:*
21. What is your principal occupation?*
23. List the skills or qualifications you could bring to this board, commission or committee:*
25. List the associations or institutes with which you are closely associated, or serve as a director or officer:*
27. Statement of Interests
    Statement of Interests
28. Upload Completed Statement of Interests*
30. A majority of official members are required to be in attendance in order for boards, commissions & committees to conduct business.*

    By checking this box you agree to meet the attendance expectations and participate in events.
32. Signature of Applicant:*
34. By checking this box I acknowledge that I am electronically signing this application.*

    1. Electronic Signature
35. Date:*
    Date:
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37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit Submit and Print

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