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2. Name
3. Email Address
5. Physical Address
7. Primary Phone
8. Other Phone
10. How long have you resided at this address?
12. Place of Work / Title
14. Why do you wish to serve on the DAB?
16. Please list any government or nonprofit board, committee, or commission on which you currently serve:
18. Please list any experience or education that you believe qualifies you for the position:
20. As defined by the Town of Pittsboro Code of Ordinances, attendance at board meetings is a requirement of this appointment. Are you able to commit to this requirement?*

    1. yes
    2. no
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field