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2. Applicant Information...

4. First Name
5. Last Name
7. Email Address
9. Phone Number (Optional)
11. Address1
13. Address2
15. City
16. State
17. Zip

19. Applicant Experience...

21. Please describe your relevant experience in the space below:
23. Experience in working on accessibility issues pertaining to language access other than English:
25. Participation in outreach where you are engaging community members:
27. Please select all that apply:

    1. Humboldt County Resident
    2. Affiliated with an organization serving Humboldt County Residents
    3. None of the Above

29. Organizational Information (if applicable)...

31. Name of organization you represent:
33. Organization Website:
35. Services organization provides:

37. I formally apply for membership with the Language Accessibility Advisory Committee for Humboldt County. I commit myself to being a member of the committee for at least one (1) election cycle from the date of the first meeting I attend. 

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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

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