Contact Information Name (First and Last) Email Phone Address Please include mailing address. City/Town State/Province - Select -AlbertaBritish ColumbiaManitobaNewfoundland and LabradorNew BrunswickNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukonAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAmerican SamoaArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoSaint Pierre and MiquelonVirgin Islands ZIP/Postal Code Residency How long have you lived in the Peace region?*Please note, some boards and committees have residency or other qualification requirements. Only those applicants that meet the requirements will be contacted. Boards & Committees Selection Please review the description of the board or committee you are interested in. The descriptions can be found on this page above this webform. Please select the board or committee that you are interested in joining. If you wish to select more than one, please select up to a maximum of three and rank them 1-3 in the space provided below. Assessment Review Board Community Services Board Economic Development Committee Municipal Planning Commission Peace Regional Healthcare Attraction & Retention Committee Peace Regional Subdivision and Development Appeal Board Peace River Municipal Library Board Boards & Committees Selection - RankingIf you selected more than one board or committee from the above list, please rank them from 1-3 here, with 1 being the one you are most interested in joining: Confirmation By checking this box, I confirm I have read the description, terms of reference, or bylaw for the respective board or committee. Other Town Boards/Committees Are you currently serving on a Town of Peace River board/committee? Yes No Other Boards/CommitteesDo you serve on any other boards/committees? If yes, please specify: Time to CommitHow much time do you have to volunteer for this board/committee? Why are you Interested?Please explain why you are interested in serving on this board/committee: Professional BackgroundPlease provide an overview of your professional or occupational background: Other experiencePlease provide your previous experience on boards/committees or volunteering: Other skills or expertiseWhat skills, strengths, or expertise will you bring to this board/committee? GoalsWhat goals do you hope to achieve by being a member of this board/committee?Applicants must provide a complete application with sufficient information. Applicants who do not fulfill this requirement may not be contacted or considered for appointment.The personal information contained on this form is being collected in accordance with the FOIP Act, for the purpose of selecting volunteers to serve on Boards and Committees of the Town of Peace River.Applicant information is reviewed by Council in determining Board and Committee appointments. This information, excluding the applicant’s home mailing address, telephone numbers, and email address, will form part of the public report to Council. Please do not include any information you do not wish to be shared publicly. If there are any questions about the collection or use of this information, contact the FOIP Coordinator or Director of Corporate Services at (780) 624-2574. In place of signature By checking this box, I certify to the best of my knowledge the information in this application is accurate and complete
