UMATILLA COLINTY Application for Appointment to the Milton-FreewaterAmbulance Advisory Committee Pleasereturn completedapplication to: Board of Commissioners 216

SE 4'hSt. Pendleton. OR 97801

Umatilla County is seekingvolunteersthat reside in the Milton-Freewater areato serve on the committee to advise the Board of Commissionerson the possible formation of a specialdistrict to provide ambulanceserviceto the Milton-Freewater ASA area.

Name of Applicant: StreetAddress:

City:
Home Phone: Occupation: Business Address:

State:

zip:

City:
Business Phone:

State:

zip:

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1. I would like to be consideredfor appointment the committeebecause: to

2. I havethe following skills, training and interests that would be beneficial:

3. Other comments/information:

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