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2. Note: All information on this form becomes public information when submitted.
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Do you reside within the City limits of Puyallup

    1. Yes
    2. No
16. Please check which City Boards and/or Commissions you are interested in volunteering for:

    1. City Council Salary Review Commission
    2. Arts & Culture Commission
    3. Civil Service Commission
    4. Design Review & Historic Preservation Board
    5. LEOFF Disability Board
    6. Library Board
    7. Parks & Recreation Advisory Board
    8. Planning Commission
    9. Lodging Tax Advisory Committee (LTAC)
    10. Senior Advisory Board
18. Occupation (if retired, please indicate former occupation or profession):
20. Education:
22. Professional and/or community activities:
24. Describe why you are interested in serving on a City Board or Commission:
26. Additional pertinent information and/or references:
28. Do you or your spouse have a financial interest in, or are you an employee or officer of any business or agency which does business with the City of Puyallup?

    1. Yes
    2. No
30. If yes, please explain:
32. To the best of my knowledge, the information herein is true and complete. I understand that falsification of this application is grounds for dismissal as a volunteer. By typing my name below I am acknowledging that I have read the above information and agree to the terms of this application.
34. First Name
35. Last Name
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field