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Date _________________________________________________________________

Name ________________________________________________________________

Home Address ________________________________________________________

City __________________________________________________________________

Telephone (Home) _________________________ (Office) _____________________

Occupation ____________________________________________________________

Employer ______________________________________________________________
Name Board Applying for ________________________________________________

What community activities are you presently involved in, or have been in the past?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Please list any other background information (business, education, personal) that might be useful.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Why do you want to be a member of the Planning Commission?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

What do you feel you could contribute to the Planning Commission?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Statement

I understand this appointment will require substantial effort on my part and I am willing to devote the necessary time to carry out the responsibilities and requirements of the position:

Signature:____________________________________     Date:______________________

Please return completed form to:

Town of Cottageville
PO Box 57
10913 Cottageville Highway
Cottageville, S.C. 29435