You are on page 1of 1

UMATILLA COLINTY

Application for Appointment to the Milton-FreewaterAmbulance Advisory Committee

Pleasereturn completedapplication to:


Board of Commissioners
216 SE 4'hSt. Pendleton.OR 97801

Umatilla County is seekingvolunteersthat reside in the Milton-Freewater areato serve


on the committee to advise the Board of Commissionerson the possible formation of a
specialdistrict to provide ambulanceserviceto the Milton-Freewater ASA area.

Name of Applicant:

StreetAddress:

City: State: zip:


Home Phone:

Occupation:

BusinessAddress:

City: State: zip:


BusinessPhone:
llrlrllllrllllllllllltltrrlrltlrrrllltrrtrrlttttttlrtrtrrlllttltlarttllrt

1. I would like to be consideredfor appointmentto the committeebecause:

2. I havethe following skills, training and intereststhat would be beneficial:

3. Other comments/information:

You might also like