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Board and Commission Application Form

  1. Personal Information

  2. Residency Information

  3. Are you a registered voter

  4. Are you currently serving on other City Boards, Commissions, or Committees?

  5. Conflicts of Interest

    Per RSA 673:7 and Chapter 5, Section 5-20 of the City Ordinances, a potential conflict of interest may exist if serving on more than one Board or Commission, as follows: Only one Planning Board member may be a member of the Zoning Board of Adjustment; either one appointed member or one ex-officio member of the Planning Board may be a member of the Conservation Commission; either one appointed member or one ex officio member may be a member of the Heritage Commission; a member of the Putnam Fund may not serve on the Trustee of the Trust Funds, and a member of the Trustee of the Trust Funds may not serve as a member of the Putnam Fund. For questions regarding conflicts of interest please contact the City Manager's Office at 527-1270, or email to NBrown@laconianh.gov

  6. Which of the following criteria makes you eligible to be a TIF Advisory Board member: (Please see TIF District map)*

  7. 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.

  8. Questions?

    For general questions regarding this form please contact Nancy Brown in the City Manager's Office, 527-1270, or email NBrown@laconianh.gov

  9. Leave This Blank:

  10. This field is not part of the form submission.