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2. Welcome to the Citizen Board and Commission Expression of Interest Form! 

   We appreciate your interest in serving your community. Please complete the form below to express your interest in volunteering for a board or commission within the City of Blair, NE.

4. First Name
5. Last Name
7. Address1
9. Address2
11. City
12. State
13. Zip
14. Number of years lived in Blair:
16. Education:
17. Occupation: (If retired, please indicate former occupation or profession.)
19. Phone Number
23. Past and Present Community Volunteer Activities Involved in:
25. I am interested in serving on one or more of the following:

    1. Airport Authority
    2. Board of Adjustment
    3. Board of Health
    4. City Council
    5. Civil Service Commission

    1. Housing Authority
    2. LB840 Committee
    3. Library Board
    4. Park Board
    5. Planning Commission
27. Why would you like to serve? Please discuss specific interest, experience, and qualifications which would make you an effective board member.
29. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) all information provided is to the best of your knowledge and ability, 2) your information is subject to the Nebraska Public Records Statutes, 3) as public information, it may be requested by news media representatives or discussed in public meetings.

    1. I agree
31. Electronic Signature
32. Date:
    Date:
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field