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2. First Name *
3. Last Name*
4. Email Address*
6. Have you lived in Blaine County for at least two (2) years?*
   -- Select One --YesNo

   Please select one.

7. Do you currently live within unincorporated Blaine County?*
   -- Select One --YesNo

   Please select one.

9. Street Address*

   To verify that you live in unincorporated Blaine County.

10. Letter of Interest*

    Please attach your letter of interest outlining your interested in serving on the Blaine County Planning & Zoning Committee.

12. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
14. Electronic Signature
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16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

* indicates a required field