Multnomah County - Food Service Advisory Committee

INTEREST FORM FOR FOOD SERVICE ADVISORY COMMITTEE MEMBERSHIP

We thank you for your interest in the Multnomah County Food Service Advisory Committee and your time taken to complete this form.

In order to assess qualifications for appointment, it is important to fill out this form as completely as possible.

Should you have any questions regarding this form, please reach out to Debbie.Flinchbaugh@multco.us

Email*

Name*

Street Address*

City, State and Zip*

Phone Number*

Phone

Are you a resident of Multnomah County?*

Select

Support of the Industry*

In the space below, please tell us how you support the food service industry work in Multnomah County. Examples of this work include but are not limited to:

Owners, managers or other employees of: full service restaurant, limited service restaurant, mobile, vending or commissaries, fast food operation, temporary restaurant, non-profit restaurant, and equipment vendors.

Examples of public categories include but are not limited to: non managerial food service employees, public interest groups, educational programs in food technology and issues, legislators, legal, financial, health care professionals and individuals with an expressed interest.

Applicant Experience*

In the space below, tell us about your previous volunteer experience:

Committee Work*

Membership will entail participating in committee work, usually about 2 hours total every other month. Are you able to make the time commitment necessary to participate at this level?

Select

Affirm*

My signature affirms that all information is true to the best of my knowledge and that I understand that any misstatement of fact or misrepresentation of credentials may result in this application being disqualified from further consideration or, subsequent to my appointment to a board/commission, may result in my dismissal.

Please type in your name below

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