Board of Trustees Application Form

2. Personal Information

4. First Name*

5. Last Name*

7. Physical Address*

9. City*

10. State*

11. Zip Code*

13. Mailing Address

    Please provide if different than physical address.

15. City

16. State

17. Zip

19. Home Phone Number*

20. Cell Phone Number*

22. Email Address*

24. Occupation*

    Enter none or retired if not currently employed.

26. Business Address

28. Business Phone Number

30. Are you a qualified elector of the City?*

    1. Yes
    2. No

32. Are you a customer of GEUS for residential or business use?*

    1. Yes
    2. No

34. Are you currently serving or have you previously served on other Boards, Commissions, or Committees?*

    1. Yes
    2. No

36. If yes, which*

38. Please List Areas of Special Interest

Leave This Blank:


39. 1. Receive email copy
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field