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2. Authorized by the "Citizen Service Act" (A2784) on October 19th, 2009
4. Full Name*
6. Please enter up to three municipal authorities, boards, or commissions you'd like to apply to:*
8. City*
9. State*
11. Additional Information

    Please list any education, prior volunteer experience, work-related experience; or other civic involvement which could be of use to the authorities, boards, or commissions that you listed above. 

13. Optional: Attach a Resume If Necessary
15. Personal Information Not Subject to Public Disclosure*
17. Primary Phone Number*
18. Secondary Phone Number
20. Address*
22. E-Mail Address

24. *The information in this section is considered personal information, and is therefore deemed confidential for the purpose of P.L. 1963, c. 73 (C.47:1A-1 et seq.) and P.L. 2001, c. 404 (C.47:1A-5 et al.). 

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field