CITY OF HARTFORD BOARDS AND COMMISSIONS APPLICATION FORM, “The City of Harford weleomes your interest in serving on @ Board or Commission. Please compte this form (please print legibly), attach your resume ora brief biography, and submit to the Mayor's Office, You may mail the form to 550 Main Street, Hartford, CT 06103 or fax it t6 860-722-6606, Should you have any questions, please contact Linda A. Bayer at 860-757-9500 or Bayel001 @hartiord gov. Name: Fist ME Last ‘Boatd(s)(Commission(s) in which you are interested ‘Qualifications (Please indicate any experionceskillsintrests that qualify you to serve on the Board(s) or you are interested Address: ‘Siveet Adres, including apartment floor, et) City/Town: State: Zip Code: Contacts: Home! Work: cal Fax: Email Addess: Place of Employment (Include, name, department, and address: ‘Are you currently serving on a Board or Commission? Yes No yes, please list name(s) of Board(sCommission(s): Organizational memberships and/or professional affiliations: Are you currently a registered voter? _ Yes. _ No. If yes, what is your politcal afiition/party? Comments