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2. Please select the Board, Commission, or Committee applying for

   1. ADA Task Force
   2. Agricultural Commission
   3. Board of Appeals
   4. Board of Health
   5. Celebrations Committee
   6. Community Preservation Committee
   7. Conservation Commission
   8. Conservation Restriction Advisory Committee
   9. Council on Aging
   10. Cultural Council
   11. Energy Task Force
   12. Finance Committee
   13. Historical Commission

   1. Household Recycling Committee
   2. Housing Authority
   3. Land Stewardship Committee
   4. Library Trustee
   5. Long-Term Capital Requirements Committee
   6. Memorial Day Committee
   7. Personnel Board
   8. Planning Board
   9. Recreation Commission
   10. Scholarship Advisory Committee
   11. Trails Committee
   12. Youth Commission
   13. Other
4. Please provide the following information:
6. First Name*
7. Last Name*
9. Email*
11. Address
13. City
14. State
15. Zip Code
17. Home Phone
18. Occupation
20. Background
22. Other Committees
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field