Community Member Application

Applicant Information

Title

Mr. Ms. Dr. Other

If other, please specify

Last Name

First Name

Contact Information

Address	City
Province	Postal Code

Phone - Residence	Phone - Business
Email

Current Occupation

Employer

Attach Résumé

Commission/Committee/Board/Panel/Task Force for which you are applying (please choose one to three items; hold down Ctrl while clicking to select multiple options).

Have you previously been a member of a Commission, Committee, Board, Panel, or Task Force for the City of New Westminster?

	Yes

	No

What skills and goals will you bring to the Commission/Committee/Board/Panel/Task Force?

Business/Work experience in the past five years

Educational background/Professional qualifications

Community/Volunteer activities in the past five years

Consent

I consent to the release of the information on my application and understand that it will be made available on as needed basis to New Westminster City Council, civic staff and any applicable civic agencies (i.e. New Westminster Public Library), for the purpose of making appointments to Commissions, Committees, Boards, Panels and Task Forces, and, if I am appointed, for contacting me regarding meetings and sending information.

Date

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