By signing below, I verify that my residence is
within the limits of the City of Arkadelphia.
Signature
_______________________________________________________________________
Registration for Appointment/Reappointment
to Boards, Committees, or Commissions
Name:
________________________________________________________________
Mailing Address:
________________________________________________________
E-mail Address:
_________________________________________________________
Home Ph. Number:
________________
Work Ph. Number:
________________________
Mobile
Ph. Number:
________________
Board, Committee, or Commission on which you hope to serve:
______________________________________________________________________