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SRLJC Application Form

  1. SPOKANE REGIONAL LAW AND JUSTICE COUNCIL MEMBERSHIP APPLICATION

  2. Employment History:

  3. Educational Background:

  4. Community Related Activities:

  5. SERVICE

  6. Please list current and past position(s) held on City / County Boards, Committees, and/or Commissions:

  7. UNDER THE PUBLIC DISCLOSURE ACT, ALL INFORMATION IN THIS APPLICATION IS SUBJECT TO DISCLOSURE UPON REQUEST EXCEPT THE FOLLOWING INFORMATION IS NOT SUBJECT TO DISCLOSURE: RESIDENTIAL ADDRESSES, RESIDENTIAL TELEPHONE NUMBER, PERSONAL WIRELESS TELEPHONE NUMBERS, AND PERSONAL ELECTRONIC MAIL ADDRESSES.

  8. 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.

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