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Washington State Association of Counties 206 Tenth Avenue SE Olympia, WA 98501 (360) 753-1886 (360) 753-2842 (fax)

Boards and Commissions Member Interest Form

The following positions currently have openings for a county representative:

Council on Aging - three year term, can be elected official or staff person
Forensics Investigation Council - elected official to fulfill unexpired term through July 2012
Transportation Improvement Board - County Planner seat, four year term

Select a position from the drop down list below; deadlines for interest submittals are indicated after the title.

Position of Interest:

Name:

Title:

County:

Address:

City:

Zip:

Phone:

Fax:

Email:

If elected official, your current term ends?

Have you contacted the Board or Commission of interest or visited their website to review the meeting schedule and to determine if you are able to meet their requirements?
YesNo

As an appointee or nominee of WSAC, you will represent the interests and positions of the Association and act in the best interests of all counties. You may be required to report back to the WSAC Board verbally or in writing, upon request, about activities and decisions of the Board or Commission on which you serve. Do you agree to these responsibilities?
YesNo

Statement of Interest – Why are you interested in serving on this Board or Commission? What specific expertise do you bring to the subject area(s)?

Thank you for your interest. For questions about open positions or the application process, please contact Michelle Nelson