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Committee Reappointment Interest Form

2. Date*
   Date
4. Name*
6. Email:*
8. Street Address*
10. Zip*
12. Preferred Phone #*
14. Committee you are a member of?*
16. List of accomplishments in the last 3 years.*
18. Future Goals*
20. Questions? Please contact the Select Board at selectboard@brooklinema.gov, 617-730-2200
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field