Please Complete Each Section

Name ____________________________________________________________________________________

Home Address _____________________________________________________________________________

Mailing Address ___________________________________________________________________________

Business Address __________________________________________________________________________

Home Phone ______________________________  Business Phone _________________________________

Email ____________________________________________________________________________________

Availability _______________________________________________________________________________

Boards/Committees/Commissions I am most interested in:

1.      ___________________________________________________________________________________

2.      ___________________________________________________________________________________

3.      ___________________________________________________________________________________

Interests/Skills/Areas of Expertise _______________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Additional Comments _________________________________________________________________________

____________________________________________________________________________________________

Return Completed Form to:

Office of the Town Manager, Town of Duck

P.O. Box 8369, Duck, NC  27949