Name: ______________________      Mailing Address: ______________________________

						   ______________________________

Home Phone: ________________      Residence Address: ____________________________

Work Phone: ________________                         ____________________________



AMC 5.05.035A requires that board and commission members "shall, if legally
eligible, be a qualified voter in the Municipality of Anchorage

Are you a registered voter?          Yes ____ No ____



Board or Commission you wish to apply for: ______________________________________



Could you or a member of your family be affected financially by decisions to made
 
by the board or commission for which you are applying?  Yes ____  No _____    

If "YES", please explain: ________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________




Time available:  2 ____    5 ____    10 ____   20 ____   30 ____ hours/month


*Please include your resume or a brief outline of your experience and qualifications.*



RETURN TO:   Office of the Mayor
             Boards and Commissions
             PO Box 196650
             Anchorage, AK 99519-6650
             FAX:  (907) 343-4499