2. If you are interested in serving on a city committee, please complete the following information that can assist the Mayor in making appointments.
6. Personal Information
8. First Name*
9. Last Name*
11. Address*
13. Home Phone*
14. Phone Number*
15. Email Address*
17. Committee / Board / Commission of Interest*
18. How long have you lived in the City of Glendale?*
20. Why do you have an interest in serving Glendale?*
22. Special training or schooling that may be appropriate to a specific committee appointment:*
24. What nights are you available for meetings?*

    1. Monday

    1. Tuesday

    1. Wednesday

    1. Thursday
26. What late afternoons are you available for meetings?*

    1. Monday

    1. Tuesday

    1. Wednesday

    1. Thursday
30. Job Information
32. Employer*
33. Title*
37. Emergency Contact Information
39. First Name*
40. Last Name*
42. Address*
44. City
45. State
46. Zip Code
48. Primary Phone Number*
49. Alternate Phone Number*
51. Relationship*
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field