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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