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Kalamazoo County Board of Commissioners

KALAMAZOO COUNTY GOVERNMENT ADVISORY BOARDS & COMMISSIONS

APPLICATION FOR APPOINTMENT TO:

Environmental Health Advisory Council
 
Name: 
Occupation: 
Home Address: 
Home City: 
Home Zip: 
Home Phone: 
Business Phone: 
Cell Phone: 
E-mail Address: 
 
Certain categories need to be represented on the Environmental Health Advisory Council. Please check categories which apply to you:
Citizen at Large: 
Member of Business Community: 
Representative of manufacturing/industry: 
City Official: 
Village Official: 
Township Official: 
Recipient of County Environmental Health Services: 
Please Note: A Recipient may be anyone who receives services on a regular basis from the Environmental Health Program of the Human Services Department.
 
Please indicate experience and/or qualifications that would help make you an effective member of the Environmental Health Advisory Council.
 
Why do you desire to serve on the Environmental Health Advisory Council?
 
Verification Code:  (This helps prevent automated e-mails.)
 
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