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ATTACHMENT B <br /> ., .. 'RECEIVED <br /> ' '~ ' II BY,CITY MANAGER <br /> APPLICATION FOR ~.~)I~Tj~I~,~T.p~ _. <br /> CmZEN ADVISORY BO~=ANB~~IONS '~- ~ 6 <br /> ~ ~ III I II I II IIII I I <br /> <br /> ~~,~ ~l ~A~~'~ ~'d ~ ~,~ ,, ~a~~ ~ Zooz <br /> <br /> Mille <br /> <br /> H~ T l.~n. ~ '~ :~ ~ Day Te,~. , ~"t~~ <br /> · ~~n ~, .~ r ~ - ~a~ of ~yment ~ , <br /> <br /> ~siness ~d~s , - ~" , ....... <br /> F~ Numar (~ a~i~b~) ~ ~ ~ E-Mail (~ appl~ble) ~ <br /> <br /> ~~ ...... <br /> II I I I II II I I <br /> <br />  ONAL INfO'ON . <br /> ~ ~ ~un~ supers d~e~ and ~e~ ~ ap~nt per ~ ~o ~nt ~e d~e~ of ~ ~mun~. By <br />.. ~~ ~ ~~ ~, ~u ~n ~lp ~e ~ ~7 ~ ~ · ~e ap~~ ~ ~e d~ <br /> ~n~. ~p~n~ am ~emd w~ ~a~ ~ ~, ~ ~ ~al ~in, a~, mSg~n, ~ ~s, <br /> ~d~n, ~ dl~bS~. In s~e in~nc~, howe~ ap~n~nt to ce~in ~~mi~s may ~ ~ u~n <br /> ~ to fig s~c p~s ~ ~e ~a~mi~. <br /> <br /> ~a~ ~ ~ a~ ~xes: <br /> <br /> ~Mal, D F~e .... <br /> ~ 18and Under ~ 19-25 ~ 26-35 ~ 36-45 ~ 46- 55 <br /> · ~'~: 65 ,,~ ~d a~ve .... - <br /> <br /> ~ Af~n ~ed~n ~ ~edcan Indian/Alaskan Native ~ ~ian/Pacific Islander <br /> · ~ Hispanic ~ Middle Eastern ~ MulUmdal <br /> . ~ ~it~umpean Amed~n <br /> <br /> Disabili~: ~ Yes ~ No If yes, please describe <br /> <br /> Fluent in languages o~er ~an English? ~ Yes ~ No ~I~ ~ngu~e(s)? <br /> <br /> R~ S*~. ~t -X~~l~ <br /> <br /> <br />