Valley Center, KS

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Name*

Maiden Name

Sex*

Male

Female

Home Address*

Home Phone Number*

Business Address*

Business Phone Number*

Occupation*

Email Address

Length of Residency in Valley Center*

Are you a registered voter*

Yes

High School

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Hobbies

Are you currently serving on other Boards, Commissions, or Committees?*

Yes

If yes, which

Have you served on a Board, Commission, or Committee before?*

Yes

If yes, which

Please list organization memberships and positions held

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Board Application Form