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2. You will be contacted when the appointment process is scheduled for City Council to conduct interviews and consider appointments to the Economic Development Committee.
4. First Name*
5. Last Name*
7. Primary Phone*
8. Alternate Phone
10. Home Address*
12. Address 2
14. Email*
16. Occupation/Profession
17. Employer Name
19. Are you 16 year of age or older?*

    1. Yes
    2. No
20. Do you represent a local business or industry within the limits of the City of Beaumont?*

    1. Yes
    2. No
22. Questions
24. Are you aware of any conflicts, financial or otherwise, which could affect your appointment as an Economic Development Committee member?

    1. Yes
    2. No
26. If you answer "Yes", please explain*
28. Qualifications - Briefly state your qualifications, including any education, skill, or background related to economic development functions*
30. Additional Information
32. Resume
34. Additional Information
Leave This Blank:


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

    This field is not part of the form submission.

38. Submit

* indicates a required field