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Town of Lebanon Volunteer Form

One of the foundations of good government in a small town is volunteer participation by residents on the various boards, commissions and committees, which play a vital role in the functions of local government. The actions of these boards, commissions and committees shape the direction and future of our Town.

Thank you for your interest in serving. Please provide the information requested below: Name: Date:

Address:

Phone numbers

Home: Cell: Work:

Email:

Are you registered to vote in Lebanon?

Party Affiliation: Democrat Republican Unaffiliated

Other (specify) Under CT Statutes, a balance of political affiliations must be maintained on all boards, commissions & committees. Briefly describe any experience, volunteer or professional, you feel would be useful to the Town and how you could apply it to the committee(s) you are expressing an interest in. Add any additional relevant information which may be useful, including education and other formal training, specialized coursework, professional licenses or certifications. Click here if any additional pages are submitted with this form.

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Cemetery Commission Energy Advisory Committee

Commission on Aging Rails to Trails Committee

Conservation & Agriculture Commission Summer Dance Fest Committee

Economic Development Commission Other (specify below)

Inland Wetlands Commission

Recreation Commission

Solid Waste Commission

Water Pollution Control Authority

Please return completed form to:

Office of First Selectman Lebanon Town Hall

579 Exeter Rd Lebanon, CT 06249

Fax: 860-642-7716

firstselectman@lebanonct.gov

Per Town of Lebanon ordinance: All members of non-elected boards and commissions in the Town of Lebanon shall be a resident of, and registered voter in the Town of Lebanon and, if for any reason he/she ceases to be a resident of or registered voter thereof, he/she shall thereupon cease to hold membership therein and such position shall be deemed vacant.

Date Form Received: _____________

Forms will be kept on file for 2 years.

For Admin Use Only.