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Item 8ACITY OF SOUTH LADE MEMORANDUM December 31, 2009 To: Shana Yelverton, City Manager From: Lori Payne, City Secretary Subject: Resolution No. 10 -001, Appoint representatives to the Standing Committee of the Southlake Program for the Involvement of Neighborhoods (SPIN) Action Requested: Approve Resolution No. 10 -001 to appoint representatives to the Standing Committee of the Southlake Program for the Involvement of Neighborhoods (SPIN). Background Information: On April 21, 2009 City Council approved amendments to Ordinance No. 598 -C which created and established a program to be known as the "Southlake Program for the Involvement of Neighborhoods" (SPIN). The amendments included a map revision and changes to the makeup of the SPIN Standing Committee which shall be composed of neighborhood representatives and other members, appointed at -large by the City Council so that the total number of committee members does not exceed twenty (20), all of whom shall be voting members. All of the neighborhood representatives shall be appointed according to neighborhoods as indicated by the approved neighborhood map. Each neighborhood representative shall reside within the neighborhood he /she is to represent. Members of the Standing Committee shall be appointed by a majority vote of the City Council for a term of two (2) years and shall serve until their successors are appointed. All members who are appointed to at -large positions shall be appointed for terms of two (2) years which expire in May at the end of their second year of service. There are currently two available neighborhood representative positions (SPINs 1 and 11), one at -large position (Youth Representative), and 13 alternate positions (all SPIN Neighborhoods, Senior and Youth). Financial Considerations: Not applicable Financial Impact: Not applicable Citizen Input/ Board Review: Not applicable Legal Review: Not applicable Supporting Documents: Resolution No. 10 -001 Listing of received applications Applications submitted for consideration RESOLUTION NO. 10 -001 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SOUTHLAKE, TEXAS, PROVIDING FOR THE APPOINTMENT OF REPRESENTATIVES TO THE STANDING COMMITTEE OF THE SOUTHLAKE PROGRAM FOR THE INVOLVEMENT OF NEIGHBORHOODS (SPIN); PROVIDING AN EFFECTIVE DATE. WHEREAS, the City Council of the City of Southlake, Texas, established the Southlake Program for the Involvement of Neighborhoods (SPIN) to provide a more available form of resident participation in the affairs of the City Council; and, WHEREAS, the SPIN Mission Statement is to provide a forum which fosters open and timely communication between citizens of the City of Southlake and City Government regarding programs, activities, and issues that affect the quality of life in the community and fosters a stronger sense of community; and, WHEREAS, under Ordinance No. 598 -C, the City Council created the SPIN Standing Committee to represent each of the designated SPIN neighborhoods with residents from each SPIN area selecting a representative; and, WHEREAS, the City Council officially names the SPIN Standing Committee members through a resolution after the SPIN area has selected a representative; and, WHEREAS, there are currently two available neighborhood representative positions (SPINs 1 and 11), one at -large position (Youth Representative), and 13 alternate positions (all SPIN Neighborhoods, Senior and Youth); now, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF SOUTHLAKE, TEXAS THAT: Section 1. The following are hereby appointed as representatives to the SPIN Standing Committee for the remainder of the specified term: Name SPIN Neighborhood Expiration #1 05/31/2011 #11 05/31/2011 Youth Rep. 05/31/2012 Alternate for #1 05/31/2011 Alternate for #2 05/31/2012 Alternate for #3 05/31/2011 Alternate for #4 05/31/2012 Alternate for #5 05/31/2011 Alternate for #6 05/31/2012 Alternate for #7 05/31/2011 Alternate for #8 05/31/2012 Alternate for #9 05/31/2011 Alternate for #10 05/31/2012 Alternate for #11 05/31/2011 Alternate Senior Rep. 05/31/2012 Alternate Youth Rep. 05/31/2012 Section 2. That this resolution shall become effective after its passage and adoption by the City Council. PASSED AND APPROVED THIS 5 t " DAY OF JANUARY, 2010. CITY OF SOUTHLAKE John Terrell Mayor ATTEST: Lori Payne City Secretary Applications received for 2009 board and commission appointments SPIN — There are two available neighborhood representative positions (SPINs 1 and 11), one at -large position (Youth Representative), and 13 alternate positions (all SPIN Neighborhoods, Senior, and Youth). Applicant Position identified Date application received Ned Ahearn SPIN 9 - Alternate 10/23/2009 Amy Brandt SPIN 1 12/22/2009 James E. Cox SPIN 11 10/02/2009 Susan Edgar Cullen SPIN 7 —Alternate 10/29/2009 John Logan SPIN 8 - Alternate 11/13/2009 Glenn Mommens SPIN 11 10/14/2009 Nora Parks SPIN 11 11/06/2009 Monique Schill SPIN 11 10/09/2009 Barbara Schlauch SPIN 5 —Alternate 12/16/2009 Winston Walker SPIN 5 - Alternate 12/28/2009 Randy Williamson SPIN 3 - Alternate 09/28/2009 N: \City Secretary \Committees \Committees 2009\Applications received for SPIN - 2009.doc Last saved on December 30, 2009 UCL ed U0 U7: oar mawara rinror CITY Of SOUTHL.AKE . 19 RECEIV- OCT 2 3 = OFFICE OF CITY SECRETARY APPLICATION FOR APPOINTMENT TO: 5 & - (name board, commission or committee) *Use a separate application fo rsa Ch board appointment desired. Ahearn Name: 'VE C-1 Employer: - a Address: Voter's Registration # ' Home Phone: Work Phone: Current and/or previous board, commission. or committee experience in the City of Southiake: + Reasons) for desiring to serve on this board, commission, or committee, and your opinion as to the purpose. goals, and duties of same: � Qualifications and experience. that would assist you in serving in this position: , Do you understand and agree that your regular attendance and active support are required from as an appointee and that noncompliance could result in removal m the board? if not appointed to the specific board or commission requested. would you be receptive to _ _serve on a different board? Southlaks_ 8 In ncl! I : I would like to represent the follawing pins: constituent Technology 1 Ht -Tech Bank / Financial _ Manut. / Distrib. _ Restaurant / Local —' mmercial Developer �I� 1 P.R. ,,,�,. Re tell / Local / Franchise _Prof SeMce (e,g. Co Corporate 1 Naltional Red 1 Local lnsuranoe, aocourtinq, ... I Q'0&Irl- rev_ ! Retail 1 Franchise law Additional information or Comments: 5400 Main Street, Suite 278, Please return this completed fame to the City 3acreta a res a, Mown Hall, , Application!! are Southiske. Taxes 76892. fax to (817) 748.8270, os emaR address: kept on Ale ipr one (4) year. after that t1mJ3 It will be neces ry reapply and update the informaGOn herein if you wish to continue to be considered for appointment- S Date' %d a po" DM: X0 -W10 From:SRG 8725443358 r �+C�IITY OF AK pE NEE DEC 2 2 2009 OFTICE OF CITY SKRETARY APPLICATION FOR APPOINTMENT TO: S P ,I_ i 0 (name board, commission or committee) * U8& a separate appiked for eaoh board appointment desired. Name: r Employer: V ayl"�`I Address: Voters Registration #' Houle Phone - - Wont Phone: ,glJ,�16 X. Email: U Current and/or previous board, commis or commife experience In the City of Southlake: Reawn.(s) for desiring to serve on this lard, commission, or committee, a your opinion as to the purpose, goals, and duties: of Mlle: Qualifications and experience. that-would assist you In serving in this position: . Do you understand and agree that your regular attendance and active support are required as an appoi and that nonco mpliance could result In remova l.from the board? If not appointed to the spec serve on a different board? or co mmission requested, would you be receptive to l ..... _ _ . ._ -..... : I Av6iq.11ki to repro seiit the Talbwing business aonstitu _ Bank I Financial Manul. / Qistrib. Restaurant / Local _ TeMnology I HI-Tech _ Commodal [?"oiler ._,_ Marketing 1 P.R. _ RaiaWrsnt 1 Franchise. Prof. Servloo (e.g, Corporate l NWonei MOW Ratell I Local Insurance, accounting, Hospital /•Hotel Realtor / Resid. pay. Ret:aU / Franchise law Additional Information or comments: Please n9urn this completed form to the City 19ercrsW8 omm. Town Hail. 1400 Main Street, •Suite 270, Swthtaka, Tome 78092, fax to (817) 748 -U7o, or small address: rj soutb1pkg tx.us. Applicatbns are kept are file for ens (1) year. After that drne it will be newmary to reapply and update the informalrmn heroin if you wlsrt to continue to be considered ror appointment. Signature date: fc� o�� a Form�rlY.ADOfW.70 1212212009 14:02 #251 P.0011001 CITY OF S—C]UTHLAKE s APPLICATION FOR APPOINTMENT TO: (n rd, commission or committee) *Use a separate application for each board appointment desired. Name; Y1F5 - -__ Employer: Address: & �A,4 L LF� v oter's Registration Home Phone: & lie 3XM Emai�I'. Current and/or Southlake: board, commission, or committee experience In the City of Reason(s) lbr desiring to serve on this board, commission, or committee, and your opinion as to the purpose, goals, and dudes of same: E" Qualifications and experience. that would aksist you in serving in this Do you understand and agree that your regular attendance and active support are required as an appgintee and that noncompliance could result in removal.from the board? If not appointed to the speofficrd or commission requested, would you be receptive to serve on a different board? qr �' ` : I5 7 southiaka Buhass Council Oniv I would like to repmaent the fbil iwjng business omsftency: :� Bank 1 Financial _ Manuf. / Distrib. _ Restaurant f Local Technology 1 HI -Tech — Commerdal Developer _ Marketing C P.R. Restaurant 1 Franchise. Prof. Service (e.g. Corporate 1 National Medical _ Retall 1 Local insurance, accounting, Please rehim this completed farm to the City SemeWe Of los, Town Hall, 1400 Main Street, -Suite 270, Southlake, Texas 76092, fax to (817) 748 -8270, or mall address: 1pjVQdWMtftke.tc.us . Applicalions are kept on file for a (1) year. After that time it will be nemsM to reapply mW update the information herein if you wish to clout' ue to I f ppointment. RECEIVE Signature: Date: f — FOFMOM2DW48.10 J ®CT °- 2 2009 ' ` OFFICE CF CITY SECRETARY Lori Pa ne From: JAMES COX I Sent: Friday, October 02, 2009 9:42 AM To: Lori Payne Subject: SPIN 11 Representative Application Attachments; SPIN 11 Application 10- 02- 09.pdf Attached is a PDF file containing my application to become the Neighborhood Representative for SPIN 11. I understand the position is vacant and I believe our neighborhoods all need proper representation. Please advise ifrnnra information is needed. I may be reached at home by phone (817- 379 -0377) or e-mail or by cell phone (817 - 320 - 3606). Thank you. James E. Cox 2904 Bristol Glen Ct. Southlake, TX 76092 CITY OF SOUTHLAKE 0 REC EIVED OCT 2 9 200 FFICE OF CITY SECRETARY APPLICATION FOR APPOINTMENT TO: I e I a S (name board, commission or com itfieLa) *Use a separate application for each board appointment desired. Name: Glace n �.� ca Q c - C u _ o _. Employer. Address: -2)en4WQQA Voter's Registration# Home Phone: *�l_L21 6 � Work Phone: Email:_ Current and/or previous board, commission, or committee experience in the City of Southlake: Reasons) for desiring to serve on this board, commission, or committee, a d your opinion as to the purpose, goals, and duties of same: 4P_ ` i• . ..,. R_ 1 ... nn n Y.. .. _ : �� .,^ F r�'-A \ ' R' Ck . Qualifications and experienc e.that -would assist you in serving in this position: 06.0 %o C Z> Mc Y ►��+ r, Do you understand and agree that your regular attendance and active support are required as an appointee and that noncompliance would result in removal.from the board? If not appointed to the specific board or serve on a different hoard? hla+' c- ` requested, would you be receptive to So 90011 O . : I would - like - to represent the foilowlrtg busfthees cons&ertiiy: Bank/ Financial Manuf. l D!Wb. Restaurant I local Technology I H# -Tech Commercial Developer Marketing P.R. Restaurant Franchise. — Prof. SerVICe e.g. Corporate I Nabonai r Medical — Detail i Locd lnsursrwe, accounting, HARnitR11tV I.Hnte! Realtor f Resid. Dem. Retail I Franchi law) - Additional lrfbrmatlon or comments: Please return this completed form to the City SWMtar $ office, Town 1 -fall, 9400 Mah Sbie •SUft 270, Southlake. Texas 76092, fax to (897) 748 -8270, or small address: WWM2gWjgWbjphg&j& ApPficsfieft kept on file for one (9) year. After that time it will be rat to reapply and update the Inman herein If vou wish to c inue to be offered for appvirirnertt• Signature: Date: C lei {� m 4 4 sSo-'A q t 6.t.vvu) CITY OF RECEIVED SOUTHLAKE NOV 13 2009 OFFICE Of C11Y Sf CO2y APPLICATION FOR APPOINTMENT TO: S 1� 1 4 ` (name board, commission or committee) *Use a separate application for each board appointment desired Name: Employer: %1c-jC t Address: I n.. - Voter's Registration # Home Phone: ?%-I l Sack - ;'9a'1 , Work Phone: Email: Current and /or previous board, commission, or committee experience in the City of Southlake: w Reason(s) for desiring to serve on this board, commission, or committee, and your opinion as to the purpose, goals, and duties of same: R .4. �► �-��•� .'te %Q-cL im "u9#wz.w Qualifications and experience.that would assist you in serving in this position:. L-"& ,K St Do you understand and agree that your regular attendance and active support are required as an appointee and that noncompliance could result in removal.from the board? A&s. If not appointed to the specific board or commission requested, would you be receptive to serve on a different board? .Vav% -- - Southlake Business Council Only I would -like to represent the following business constituency, Bank / Financial _ Manuf. ! Distrib. _ Restaurant / Local Technology 1 HI -Tech — Commercial Developer _ Marketing / P. R. Restaurant/ franchise Prof. Service (e.g. — Corporate / National Medical_ Retail / Local Insurance, accounting, ____. — Hospitality [Hotel � Realtor / Resid. Dev. Retail /f=ranchise law Additional information or comments: Please return this completed form to the City Secretary's Office, Town Hall, 1400 Main Street, .Suite 270, Southlake, Texas 76092, fax to (817) 748 -8270, or email address: I a e ci.southlake.tx.us. Applications are kept on file for one (1) year. After that time it will be necessary to reapply and update the Information herein if you wish to continue to be considered for appointment. Signature � �— Date Form Dale. 209-08-10 #0 CITY Of - SOUTHLAKE 'FF'CE OF CITY SECRET APPLICATION FOR APPOINTMENT TO.* (name board, commission or Qommittee) *Use a separate application for each board appointment desired: Name:. vt • 04M IfG Employer: 6-7 - . Address: [ � L� � �� � cis �,�F��.� � V Regi9tration # Home Phone; � q Work Phone; �/( �3 f � mail; Current andlar previc Southlake: board, c rnrnisslali, or committee experience in the: City of Reason(s) fer desiring to serve on this board, bommission, oc to the purpose, goals and dines .of same: r' A � 4k M.C.$ Wes p'oai . a . . Qualificatlons-and experience -would Assis you in serving your opin,icn as to n - this position: Do you understand and agree that your regular aftendance and active support are required as art appolntes acid that noncompllartce could rasuit in M.maval.from the board? P Ifni aPpoiinted tv the.speoific boar or corrim�s ort requested, wctuld.you ba receptivo to serve on 'a different board? Southlake Basin until Onl (w4u1d like fo re' regent the Poll . .W r business co Otuency: E3arik 1 J= lnanciai MandF ! 0latrib. F g urantl' Local Tec inology 1 H.1 Tenh Camrnerc3fal l}aSralaper' _ Marketfing :I . R ataijr:601 Franchise ^ Prof, Serv.1 to 9 � Cprpordte lNatiarigl _,_ IUtedlcal Retaq:I Local Inst►rance,:accourntirlg,, . Hasp itlit >l. llafei Realtor 1 Resld, i7eu Retail Franchise ieur Additional infibrmatlon or Wrh erlts: - _ Plesse return thl pletee form to 'tha City Se tart's Office, Town Hall, 14:00 Mein Street; Spite 270, 80uthtake, ixe .82, fax to (817) T48�5270, or em all address: 0mi& SoutnlakeAx.ua Appltcatinns ar.0 kept an_itlo:for n :; 0 year. After that time:lt wall by necessary..ty eappI and :updete.1he`informigion hore.ln:if ycpu.wish io.co .t[ . to be cansldered for;appgintment. Signature Dot£' Fo nDoW2WJ -QB-,D RECEIVED V 14 2UQ9 RE: L: IV ED NOV - 6 2069 CITY OF SOUTHLAKE 1 9 Wk,t OF CITY StUt IAI Y // APPLICATION FOR APPOINTMENT TO: (name board, commission or committee) `Use a separate application for each board appointment desired. Name: Employer: lrl /��Ge� Address: / I�� 4e 6. S-A - 77 Voter's Registration # �. Home Phone: 9/ 7- 13© Work Phone: /� 3L z Vt Email:� Current an Southlake: Reason(s) for desiring to serve on this board, commission, or committee, and your opinion to the purpose, goals, and duties of same: rn- %ryr ( i irk Qualifications and experience that-would /� In serving in this po ' ion:. Do you under�st nd and agree that youf regular attendance and active support are required as an appointee and that noncompliance could result in removal-from the board ? Illj If not appointed to the specific board or commission requested, would you be receptive to serve on a different board? V1 5 Southlake Business Council Only : I would -like to represent the following business constituency: _ Bank 1 Financial _ Manuf. l Distrib. Restaurant I Local Technology/ HI -Tech _ Commercial Developer Marketing 1 P.R. Restaurant 1 Franchise. Prof. Service (e.g. Corporate 1 National _ dical Retail 1 Local insurance, accounting, Hospitality [Hotel VRealtor I Resid. Dev. Retail 1 Franchise law Additional information or comments: Please return this completed form to the City Secretary's .Office, Town Hall, 1400 Main Street, -Suite 270, Southlake, Texas 78092, fax to (817) 748 -8270, or email address: l a ne ci.southlake.tx.us. Applications are kept on tale Vpont ear. er tha ' e it will be necessary to reapply and update the information herein if you wish to a nsidere f appointment. SignatureG�-�' Date: / z) 12zh Form Datc2009.08.10 KELLER WILLIAMS, R E A L T Y NORA PARKS REALTOR® ` E 817- 328 -1241 Cell: 817 -271 -8583 - �'av A•17_79R_2973 8 State, 114; Suite iA0 < Sau#Fil�ke, - 7808 AI68 rzaG t MC6 isJndependenlly Owned and Operated ;. OCT —9 W CITY OF SOUTHLAKE 9 OF Lr A��l_'f p N7gPPOINTMENTTQ: ' � I � - (name board, commission or c:ommNee) *Use a separate applicefion for each board appointment desired. Name: �;c Employer: Address; � �� ..,._..,� Voter's Registration # L�_ . Home Phone: ?j2 Z Q jY 2j �jq _ Work Phone: P Email.L Current and/or previous board, commission, or Comm' Mex rience In the City of Southlaice s2 — �ig� `` `� �i mmission o committee, and our pinion as r desiring to serve on tl'!l boar�di to the purpose, goals, and duties of same: ` t + I- P IA and experience.that -would assist you in serving In this position: Z kay ,. QzLLecl _ ` anc .re Hess n � Igo you understand and agree that your regular attendance and active support al required as an appointee and that noncompliance could result in removal.from the board ?_1k_L__ If not appointed to the specific board or commission serve on a different board? would you be receptive to rhVL ire r, Souttrlake Buslness Coun�ll�i ly: I would like to represent the kftw ng b ON" cor�slibuenOY: Bank ! Financial _ Manuf. l Distrib. _ Restaurant / local _ Technology 1 HI -Tech Commercial Developer — Markefing I P. R. _ Restaurant I Franchise. _ Prof. Service (e.g. Corporate I National _ Medical _ Retail I Local insurance, accounting, Hosoitality I-Hotef Realtxrr l Resid. Dev. Retail I Frar�chisa law Additional Information or - &4n�WMIM Please return this cornpleled form to the City Secretary's Office, Town Hall, 1440 Main Street, -Suite 270, Southlake, Texas 76M, fax to (817) 748.8174, or small address: I e - Applications are kept on file for one (1) year. After that time It will be necessary to reapply and update the information herein If you wish to continue to be considered for appointment. Signature: ( cl Date: 10-q �.,o HL SOUTAKE D EC 1 6 2009 OFFICE �E �;�� �,ECRETITY APPLICATION FOR APPOINTMENT TO: �` (name oard, commission or committee) *Use a separate application for each board appointment desired. Home Phone: Voter's Registratip-% - Vllerk E mall: ' Reason(s) fbr desiring to serve on this board, commission, or committee, and your opinion as to the purpose, goals, and duties of same: 5 c- !'R w and experlence.that•would assist you in serving In this position: Do you understand and agree that your regular attendance and active support are required as an appointee and that noncompliance could result in removal.from the board ? ,c If not appointed to the specific board or commission requested, would you be receptive to serve on a different board ? ^4L, &IgIlik, Southlake Business Coundill Only I would Ake to represent the following business constituency: _ Hank i Financial _ Manuf. t Qistrib. _ Restaurant ! Local Technology! Hi -Tech Commercial Developer Marketing 1 P.R. — Restaurant !f =ranchise _— Prof. Servlos (e.g. Corporate f National Medical Retell 1 Local Insurance, accounting,, Hospitality f-Notel Realtor ! Resid. aev. Retail / Franchise law Additional information or comments: Please return this completed form to the City Secretary's Office, Town Hall. 1400 Maim .Street, -Suite 270, Southlake. Texas 78092, fax to (8 17) 748 -8270, or small address: I a e f. U .0 .,Appiications are kept on file for one (9) year. After that fime it wlfi be necessary to reapply and update the lnformatlon herein if you wish to continue to be consldemd for appointment, Signature: t Datee• JA (a L0 0— Current and/or previous board, commission, or committee experience in the City of Southiake: CITY OF SQUTHLAKE 1 9 APPLICATION FOR APPOINTMENT TO: (name board, commission or committee) *Use a separate application for each board appointment desired. Name: W IVIT OAl 11444 4 j rP, Employer. Address: ,� GO s' I G 1 cT. Voter's Registration # S`I/11% Home Phone: 1 11 y8T FILE Work Phone: ? 72- , 7. Email: Current and/or previous board, commission, or committee // experience in the City of Southlake: Nb., 6 4�1E r ^f far a- Reasort(s) for desiring to serve on this board, commission, or committee, and your opinion as to the purpose, goals, and duties of same: Uew/ /,'A _w e- ja i - ¢ . `' ar er rrr re I AS a > r +�.•� Video' Q1 cv i J'fn.•�� Qualifications and experience. that- assist you in serving In this position:. as e rr re4 ( 0.34 � ece*" 'cr o a' n c e r "t Do you understand and agree that your regular attendance and active support are required as an appointee and that no ncompliance could resu in removal. from the board? x -- .• .,._ - t M AA .' 'w.. Apt 1f}f � ND/l L,/� 1N� TO 4`Y'P "x"^• � `"' ( �+S' If not appointed to the specific serve on a different board ?_; or commission requested, would you be receptive to South/ ke Businggs CounpLgril. I would -like to represent the folloWng business constituency: Bank / Financial _ Manuf. l Distrib. _ Restaurant I Local — Technology / HI -Tech Commercial Developer Marketing / F.R. _ Restaurant J 1= ranchise. Prof. Service (e.g. Corporate 1 National Medical Retail I Local insurance, accounting, u.,e„tkAfty l Wntal Realtor 1 Resid. Dev. Retail I Franchise law Additional information or comments -4,44 � eakr c�tir. ��^ r`oh. Please return this completed form to the City Secretary"s Office, Town Hall, 1404 Main Street, -Suite 270, Southlake, Texas 76082, fax to (817) 748-8274, or emall address: 112eynedcLsouthlaftbc.us. Applicaflons are leapt on file for one (1) year, After that time it will be necessary to reapply and update the information herein if you wish to continue to be d r ppoiMment. Signature: Date: FaMOM:20094*10 5EP -28 -2009 12:33 FROM PFIZER 817 491 8485 TO:98177488270 P.1/1 CITY OF SOUTHLAKE RECEIVED S E P 2 3 2009 APPLICATION FOR APPOINTMENT TO: (name board, commission or committee) "Use a separate application for each board appointment desired. I . Name: � a 1j.f1!l.6UW_<arL _....» Employer: EF 1 2.zr Z . • Address: S L Voter's Registration #� Home Phone rl 2I -3V 37 work Phone: f 0443 WEmail:_ Current and/or Southlake: board, commission, or committee experience in the City of Reason(s) for desiring to serve on this board, to the purpose, goals, and dut es of same: e4tlJ�/r li e-7, 110 1 I of rc, #..� ion, or committee, and your C.A. o.-( aL pry c..` u.r►bf'a..� 'c i If - )2114 �"' o �l)s'C- �.rtr6P..lC - Qualiflbatlons and experi that wo Id assist you to serving to PIS position: Sma n1ergJ-b0r1.960L AatAM& . 1 0 Do you understand and agree that your regular attendance and active support are required as an appointee and that noncompliance could result in removal from the board? l� .- If not appointed to the specific board or commission requested, would you be receptive to serve on a different board? UeS --V ,S,.,,QAIeke Business Council Only I would like to represent the following business constituenoy: _ Bank 1 Financial Manuf. / Distrib. _ Restaurant / Local _ Taehnolo8y I Hi-Tech Commercial Developer Marketing / P.R. _ Restaurant / Franchise Prof. Service (e.g. ._�_. Corporate t National Medical _ Retail 1 t.ocal Insurance, accounting, Hospitality /Hotel Realtor/ Resid. Dev. Retail I Franchiss law Additional information or comments: Please return this completed form to the City Secretary's Office, Town Hall, 1400 Main Street, Suite 270, Southlake, Texas 76092, Fax to (817) 748 -8270, or email address i a n ci.southlake.tx. s. Applications are Kept on file for one (1) year. After that time it will be necessary to reapply and update the information herein if you wish to continue t considered for appointment. dam Z� Signature: _... - -- D ate: �' Q We: 2009-W10