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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Employer
16. Email
18. Board you currently serve on
    -- Select One --Architectural Review Board Board of Building Code AppealsBoard of Social Services Board of Zoning Appeals Cable Television Commission Economic Development Authority Fredericksburg Arts CommissionFredericksburg Clean & Green Commission Memorials Advisory Commission Planning Commission Recreation Commission Riverfront Task ForceTowing & Recovery BoardWetlands Board Other
19. Please specify if other
21. Signature
    I hereby request consideration for reappointment to the above Board or Commission of the City of Fredericksburg, Virginia.
23. Applicant Signature: I understand that checking the box below is the equivalent of signing my name.*

    1. I Accept
25. Applicant Name*
26. Date*
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28. 1. Receive an email copy of this form.
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