Please complete the form below. All required fields are marked with an asterisk (*).
*Name:
*Address:
City:
Zip Code:
Phone: ()- x
*Email:
Place of employment:
*Employment address:
Employment city:
Employment zip code:
Employment phone: ()- x
Education:

How long have you resided in Claremont?

Please specify the Board/Committee sought?

Why would you like to serve in the capacity?

Have you served on any City Board/Committee?
Yes No

Please provide a brief biography?