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2. Email Address*
3. Date
   Date

   Date
5. Name
7. Address
9. City
10. State
11. Zip Code
13. Daytime Phone
14. Evening Phone
16. Place of Employment
18. How long have you been a Resident of Hays?
20. Name of Board(s) you are interested in serving on:
22. How much time could you devote per month?
24. Are you related to anyone who is currently serving on a Board/Committee?

    1. Yes
    2. No
25. If Yes, Explain:
27. Briefly describe why you are interested in serving on a Board/Committee for the City of Hays.
29. Please list any groups or activities that you participate in, or have previously participated in, that demonstrates your involvement in the community.
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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