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To: Chairman Remauro

I request consideration to be a member of the following committee:
Functional Committees - Human Resources Functional Committees - Land Use Functional Committees - Public Services Functional Committees - Rules & Legislative Affairs Functional Committees - Transportation Functional Committees - Waterfront Functional Committees - Youth Services Area Committees - Clifton Concord Stapleton Area Committees - Mariners Harbor Port Richmond Area Committees - Rosebank Fort Wadsworth Area Committees - West Brighton St. George Area Committees - Westerleigh Willowbrook Silver Lake

Name *

Address *

Phone *

Email

Cell Phone

Interest in District *:
Resident      Business      Agency Representative

If Business or Agency Representative, please provide name, address and contact information *:

Membership in other organizations *:

Previous Community Board service *:

Reason for joining committee *:

Area of interest or expertise *:

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