Valley Center, KS

Contact Information

Full Name*

Address*

Phone Number

City*

State*

Zip Code*

Email Address

Number of years you have lived in Valley Center?*

Questions

I Am Interested In Serving On The Following Board(s)*

Please state why you are interested in serving on this Board/Commission/Council and indicate what expertise and/or capabilities you would bring to this Board/Commission/Council.

Restrictions

Some restrictions apply to City Board or Commission appointments, so this information is needed to assure compliance with these restrictions

What other boards (city, county, school, hospital, etc.) or elected offices are you currently serving on? What other boards (city, county, school, hospital, etc.) or elected offices have you served on? Please list*

Please list any present and past community volunteer activities*

To the best of your knowledge, would the appointment on your desired Board/Commission/Council create any conflicts of interest due to your employment or business endeavors? If yes, explain.*

Signature

If I Am Selected To Serve On The Board(s), I Will Participate.

Signature*

Date*

Board of Interest Form

Contact Information

Questions

Restrictions

Signature