The City of LaFayette extends an invitation to serve on various boards, commissions and committees appointed by the City.  If you have interest in serving your community, please complete this form and return to City Clerk, City of LaFayette, P.O. Box 89, LaFayette, GA, 30728; fax to (706) 638-7465; or return to city clerk at LaFayette City Hall at 207 S. Duke St.

Please Print Clearly

Name______________________________________________      City resident __Yes __ No

Home address_______________________________________________________________

Home phone____________________________ Work phone __________________________

Email: ______________________________________________      Retired       __Yes   __No

     I would be interested in serving on the following boards, committees or commissions:

     __  Airport Advisory Committee                              __  Housing Authority Board

     __  Building Appeals Board                                     __  Library Board

     __  Development Authority (industry)                      __  Planning and Zoning Committee

     __  Downtown Development Authority                     __  Recreation Advisory Committee

     __  Historic Preservation Commission                       __  Zoning Appeals Board

Please circle days you are NOT available to meet:  Mon   Tues   Wed   Thurs   Fri

Times available to meet:  8 a.m. – noon       noon – 1 p.m.     1 p.m. – 5 p.m.     After 5 p.m.

Education (circle one):  High School    2-Year Degree    4-Year Degree    Post Graduate Degree

Place of employment__________________________________________________________

Describe past Community service _______________________________________________

Personal references (please list at least 3 and contact information):

_________________________________        _________________________________________

_________________________________        _________________________________________

_________________________________        _________________________________________

Applicant’s signature _________________________________________________________

On behalf of the City of LaFayette, thank you for assisting us.  Hopefully, we will be able to find a place for you to serve as a volunteer on the board of your choice.  for more information, please contact the City of LaFayette at (706) 639-1500.

Thank you,

H. Neal Florence, Mayor

City of LaFayette