Name:
 

Home Address:
 

Occupation/Job Title:
 

Place of Employment:
 

Work Address:
 

Home Phone:
 

Work Phone: 

Cell Phone:
 

Email

Preferred Method of Contact:

 Home Phone
 Work Phone
 Cell Phone 

List your experience/expertise relevant to a position on the Parks & Recreation Advisory Board.
 

List your professional associations or any special honors you have received.
 

List your previous civic involvement.

Why would you be a good addition to the Parks & Recreation Advisory Board?
 

What cities have you lived in, other than Lenexa?
 

How many years have you lived in Lenexa?