Application Form

2. First Name*

3. Last Name*

5. Address1

7. Address2

9. City

10. Province

11. Postal Code

13. Home Phone*

14. Work Phone

16. Cell Phone

17. Email*

19. I am seeking nomination to:*
    -- Select One --Municipal Advisory Committee on Accessibility Issues (Maple Ridge / Pitt Meadows)Agricultural Advisory CommitteeCommunity Heritage CommissionEconomic Development CommitteePublic Art Steering CommitteeSocial Policy Advisory CommitteeActive Transportation Advisory CommitteeEnvironmental Advisory Committee

21. Position (if applicable)

    Please enter the position you are interested in filling - i.e., member representing the business community, member representing the youth population, member representing the senior population, etc. Positions vary by Committee and are listed in the Membership section of the bylaws.

23. Reasons & Interests in Applying

25. Relevant Background, Experience & Expertise

27. What do you hope to contribute by your participation?

29. Resumé

    Please upload a current resume.

Leave This Blank:


30. 1. Receive email copy
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field