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2. 
3. City Clerk
   510 North Baker Street

   Mount Dora, FL 32757

   (352) 735-7142 Office
5. Application to Serve as a Board or Committee Member for the City of Mount Dora
   Please complete all of the date fields listed below.
7. First Name*
8. Last Name*
10. Address1*
12. Address2
14. City*
15. State*
16. Zip*
18. Phone Number*
20. Email Address*
22. Provide a brief statement relating to your education, experience and reason for wishing to serve*
24. Resume or additional attachments (not required)
26. Boards on which you wish to serve*
28. Upon Completion
    This form will be submitted to the City Clerk's Office.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

* indicates a required field