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19 <br />CITY OF GREENSBORO <br />INTEREST FORM FOR SERVICE ON BOARDS AND COMMISSIONS <br />1. NAME <br />2. ADDRESS (HOME) <br />(WORK <br />(E-mail address) <br />3. TELEPHONE NUMBER: WORK <br />4. GENDER: FEMALE <br />5. RACE: CAUCASIAN <br />HISPANIC <br />MALE <br />HOME <br />AFRICAN-AMERICAN <br />AMERICAN INDIAN OTHER <br />6. PROFESSION (TITLE): <br />7. GREENSBORO COUNCIL, DISTRICT WHEREIN NOMINEE RESIDES: <br />(MUST RESIDE IN THE CITY OF GREENSBORO) <br />8. SPECIFIC CITY BOARD/COMMISSION OF INTEREST <br />9. CITY ACADEMY GRADUATE <br />10. LEASE ATTACH RESUM <br />SIGNED: <br />Applications will be pursed after two years. Please consider reapplying at that time if you remain interested <br />in serving on a Board and have not yet been appointed. <br />Send to City Clerk, P.O. Box 3136, Greensboro, NC 27402-3136 - 336- 373-2397 -fax 336-574-4003 <br />E-mail: Betsey.Richardson(cr~reensboro-nc.eov <br />Revised November 2010 <br />