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2. 
3. NOTE: Under Missouri State Statute, 610 RSMo, otherwise known as the Sunshine law, all information submitted is public.
7. First Name
8. Last Name
10. Street Address
11. City
12. State
13. ZIP Code
15. Phone Number
16. E-Mail Address
18. Do you live in the city limits of Republic?

    1. YES
    2. NO
20. Which council ward do you live in? Refer to City of Republic Map and select "Ward" option to view.

    1. Ward 1
    2. Ward 2
    3. Ward 3
    4. Ward 4
22. Are you generally available Monday evenings between 6:00 p.m. and 8:00 p.m.?

    1. YES
    2. NO
24. Why would you like to serve on the Republic Planning & Zoning Commission?
26. In your view, what role does this commission play in the development of Republic?
28. What type of civic or volunteer activities are you involved in?
30. What type of education or life experience do you have that would be a benefit?
32. Is there any additional information you would like the mayor or city council to consider regarding your application?
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34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field