Madelia City Committee or Commission Application

Committee/Commission being applied for:

Date:*

Email*

Name:*

First Middle Last

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone Number:*

Briefly describe why you want to serve on this committee:

Please briefly describe any special background or experience you have which would be helpful to this committee/commission:

Please briefly describe your educational background, especially any that would be helpful on this committee/commission:

If you have served on any Social, Fraternal, Patriotic, Governmental, or Service organization, please describe which, when, & any special offices that you held:

If you are employed, please provide the name & address of your employer, your position & whether your employer does business with the City of Madelia:

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(507) 642-3245

Madelia City Committee or Commission Application