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25 <br />RETURN THIS APPLICATION TO: <br />Deborah Gore, Clerk to the Board <br />Post,lDffice Box 249 <br />Bolivia, North Carolina 29422 <br />Email Your Application To: <br />dgo re(rr~. b ru n sco. n et <br />Phone Number: 910-253-2017 <br />Fax Number: 910-253-2004 <br />BRUNSWICK COUNTY <br />APPLICATION FOR APPOINTMENT TO BOARDS AND COMMITTEES <br />The undersigned is interested in community service and provides this information for use by the Brunswick County <br />Board of Commissioners in considering his/her qualifications for appointment to boards or committees. <br />PLEASE PRINT <br />I am interested in serving on: <br />Full Name: <br />List complete address: (Please include street name, town, post office box number, all that is applicable) <br />Home Phone: Area Code: <br />Email Address: <br />Mobile Number: <br />Permanent Resident of Brunswick County [Yes] [No] How many years? <br />Registered to vote in Brunswick County [Yes] [No] <br />Present Job/Employer Address: <br />Fax Number <br />Past Employment: <br />Educational Background/Experience/Training that would qualify for appointment: <br />Are you currently serving on any other Boards in Brunswick County: [Yes] [No] <br />