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2. Appointment Sought
4. Name
6. Commission District of Residence

   1. District 1
   2. District 2
   3. District 3

   1. District 4
   2. I don't know
7. Numbers of Years a Greene County Resident
9. Home Address
10. City
12. Phone
13. Email
15. Occupation
17. Are you a registered voter?

    1. Yes
    2. No
18. Do you reside within the city limits?

    1. Yes
    2. No
20. If so, please indicate which city.

    1. Greensboro
    2. Siloam

    1. Union Point
    2. White Plains

    1. Woodville
22. Elective Offices Held (Current & Former)
24. Positions Held on Other Public Boards / Committees / Authorities (Current & Former)
26. Positions Held in Other Organizations (Current & Former)
28. Educational Background Relevant to Position Being Sought
30. Other Background, Qualifications, and/or Involvement Relevant to Position Being Sought
32. Reason(s) for Seeking this Appointment
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field