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2. Board, Commission, or Committee applying for
4. Applying For:

   1. Regular Member
   2. Alternate Member
   3. Will Accept Either
6. Personal Information
8. First Name*
9. Last Name*
11. Address*
13. Unit/Apt #
15. City*
16. State*
17. Zip*
19. Home Phone Number*
20. Cell Phone Number
21. Business Phone
23. Email Address*
25. Occupation & Company*
27. Education and Training
29. Organization Membership Information
31. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
33. If yes, which
35. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
37. If yes, which
39. Please list organization memberships and positions held
41. Reason For Applying
43. Code of Conduct

    1. Code of Conduct

    Please Note:  All Appointees of the Select Board are required to read the Code of Conduct.  By checking this box, you agree to adhere to the Code of Conduct set forth by the Select Board Policies and Procedures, Section 38.0.  This document can be found at https://www.town.billerica.ma.us/932/Select-Board-Policies-and-Procedures

45. Resume
46. Cover Letter
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit Submit and Print

* indicates a required field