2. Select the Board, Commission, or Committee applying for*
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4. Personal Information
6. First Name*
7. Last Name*
9. Address1*
11. Address2
13. City*
14. State*
15. Zip*
17. Phone Number (Please Specify Home/Mobile/Business)*
19. Email Address
21. Residency Information
23. Are you a resident of Waynesboro?*

    1. Yes
    2. No
25. Education and Hobbies
27. Background and Qualifications
29. Experience and/or Profession:
31. Reason for wanting to serve:
33. Organization Membership Information
35. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
37. If yes, which
39. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
41. If yes, which
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