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2. Applying for (check all that apply):

   1. Board of Adjustment
   2. Historic Landmark Commission
   3. Parks and Recreation Advisory Committee
   4. Planning Board
   5. Wrightsville Beach Marketing Committee
4. Name (first, middle, and last):
6. Street Address:
8. Mailing Address:
10. Telephone (home):
11. Telephone (business):
13. Email Address:
15. Occupation:
17. Education:
19. Are you registered to vote in the Town of Wrightsville Beach?

    1. Yes
    2. No
21. Do you own or rent a home in Wrightsville Beach?

    1. Own
    2. Rent
23. If you previously made your home in a place outside of Wrightsville Beach, have you abandoned that home with intention of making Wrightsville Beach your home at this time?

    1. Yes
    2. No
25. Do you presently have any intention to leave Wrightsville Beach permanently and make your home in some other location?

    1. Yes
    2. No
27. Please state any personal, occupational, or previous experience that you feel might be pertinent to service on the board, commission, and/or committee that you are applying for:
29. Please state your interest in serving on the board, commission, and/or committee that you are applying for:
31. Number of years as Resident:
33. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    "Upon appointment to a Board/Committee, the information contained herein becomes a matter of public record per North Carolina General Statute 132-1."

    1. I agree.
35. Electronic Signature
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field