Parking Study Stakeholder Advisory Group

2. Date
   Date

4. First Name*

5. Middle Name

6. Last Name*

8. Phone*

10. Address1*

12. Address2

14. City*

15. State*

16. Zip*

18. Occupation*

19. Employer*

21. Work Address1

23. Work Address2

25. City

26. State

27. Zip

29. Work Phone

30. Fax

32. Email*

34. I am interested in serving on the Parking Study Stakeholder Advisory Group as a:*

    Please check one

    1. Downtown Business Owner
    2. Downtown Employee
    3. Ferry Commuter

    1. PSNS Employee
    2. Olympic College Student
    3. Other
36. If other, please explain

38. Why are you applying for this appointment?

40. Which of your personal and / or professional interests prompted you to apply for this appointment?

42. Please list your qualifications for this appointment (include skills, activities, training, education):

44. We welcome your willingness to serve Bremerton. For more information please contact the City Clerk's Office by phone at 360-473-5323 or via <a class="Hyperlink" target="_self" href="mailto:City.Clerk@ci.bremerton.wa.us">email</a>.<br><br> Pursuant to the Washington Public Disclosure Act, (RCW 42.56), this form constitutes a public record and is subject to public release upon request. Prior to release, the following information may be redacted pursuant to RCW 42.56.250(3): Residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, driver’s license numbers, identicard numbers, and emergency contact information of employees or volunteers of a public agency, and the names, dates of birth, residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, and emergency contact information of dependents of employees or volunteers of a public agency.<br><br> Applicants are considered for appointment without regard to race, color, religion, gender, national origin, sexual orientation, age, genetic information, marital or veteran status, or the presence of any disability.

    We welcome your willingness to serve Bremerton. For more information please contact the City Clerk's Office by phone at 360-473-5323 or via email.
    
    Pursuant to the Washington Public Disclosure Act, (RCW 42.56), this form constitutes a public record and is subject to public release upon request. Prior to release, the following information may be redacted pursuant to RCW 42.56.250(3): Residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, driver’s license numbers, identicard numbers, and emergency contact information of employees or volunteers of a public agency, and the names, dates of birth, residential addresses, residential telephone numbers, personal wireless telephone numbers, personal electronic mail addresses, social security numbers, and emergency contact information of dependents of employees or volunteers of a public agency.
    
    Applicants are considered for appointment without regard to race, color, religion, gender, national origin, sexual orientation, age, genetic information, marital or veteran status, or the presence of any disability.

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46. 1. Receive an email copy of this form.
47. Email address

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48. Submit

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