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Committee / Board Membership Application


  1. 1. Step One
  2. 2. (For City Use Only)
  • Step One

    1. Sex:
    2. Which age group do you represent?
    3. Have you ever been arrested for and / or convicted of a felony charge?
    4. Last year of formal education attained:
    5. Have you ever served on a LeClaire city committee board in the past?
    6. Please check whichever city committee(s) or board(s) that you may be interested in serving on:
    7. I 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.