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Committee Reappointment Interest Form

2. Date*
   Date

4. Name*

6. Street Address*

8. Zip*

10. Preferred Phone #*

12. Committee you are a member of?*

14. List of accomplishments in the last 3 years.*

16. Future Goals*

18. Questions? Please contact the Select Board at selectboard@brooklinema.gov, 617-730-2200

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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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