Town of Stratham APPLICATION FOR APPOINTMENT

____ BOARD OF ADJUSTMENT

____ BUDGET ADVISORY COMMITTEE

____ CONSERVATION COMMISSION

____ HERITAGE COMMISSION

____ PLANNING BOARD

____ PUBLIC WORKS COMMISSION

____ RECREATION COMMISSION

____ OTHER ______________________

____ AD HOC CONSERVATION BOND SUBCOMMITTEE

APPLICANT’S NAME ______________________________ PHONE NO. ________________

ADDRESS ____________________________________________________________________

E-MAIL ADDRESS ____________________________________________________________

REGISTERED VOTER OF STRATHAM? YES ____ NO____

NUMBER OF YEARS AS A RESIDENT ________________

I WOULD LIKE TO BE CONSIDERED BY THE BOARD OF SELECTMEN FOR APPOINTMENT TO A TOWN BOARD/COMMISSION/COMMITTEE INDICATED ABOVE BECAUSE:

I FEEL THE FOLLOWING EXPERIENCE AND BACKGROUND QUALIFIES ME FOR THIS POSITION:

SIGNATURE OF APPLICANT ___________________________________________________

DATE ______________________