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City of Medford Keep Medford Beautiful - Interest Form

Name*

Address*

City*

Phone*

Phone

Email

Are you 18 years or older?*

Yes

No

Which of the Following Best Describes you?

Asian or Pacific Islander

Black or African American

Hispanic or Latino

Native American or Alaskan Native

White or Caucasian

Multiracial or Biracial

A race/ethnicity not listed here

Prefer not to say

Have you ever served on a Board or Commission?*

Yes

No

If yes, what type of Board / Commission and when?

Relevant training, qualifications and/or interest*

Interests / Hobbies

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Please include a resume / CV if available and relevant.

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