Action Center / Board and Commission Application / Davenport, Iowa

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Board and Commission Application

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Click here to download the Financial Disclosure Form if necessary

* Denotes a required field

Name

Address

City

State

ZIP

Zip-Zip +4
Second portion of ZIP Code is optional.

Primary Phone

Primary Phone Area Code-Primary Phone Prefix-Primary Phone Line Number ext Primary Phone Extension

Secondary Phone

Secondary Phone Area Code-Secondary Phone Prefix-Secondary Phone Line Number

Gender

Male

Female

Not Specified

Race / Ethnicity

Financial Disclosure

Do you or a member of your immediate family have more than 5% ownership interest in an organization?

Do you or a member of your immediate family serve in an executive/management position with financial decision-making authority in an organization which does or could provide goods or services to the City of Davenport?

Do you have any financial disclosures?

Yes No

If yes, please list The name(s) of the business, type of interest, and self or family member

Company (Employer)

Occupation

Bio

Experience, Education which qualifies you for this board/commission

What contributions can you make, or state the reason for applying

Please Do Not Complete The Following Field

Are you a robot?

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