Board or Commission Interest Form
Name: _____________________________________________
Address: ___________________________________________
Phone: _____________________________________________
Email: _____________________________________________
Employment: _______________________________________
Job Title: ___________________________________________
Please list the Boards and/or Commissions that you are interested in serving on:
1. _____________________________________ 2. _____________________________________
3. _____________________________________ 4. _____________________________________
1. Air Port Commission 8. Historical Commission
2. Board of License Commissioners 9. Human Rights Commission
3. Board of Park Commissioners 10. Planning Board
4. Conservation Commission 11. Trustees of Public Burial Grounds
5. Council on Aging 12. Trustees of the Public Library
6. Disability Commission 13. Zoning Boards of Appeals
7. Energy Commission
Please save completed form as a document, attach a resume, and email to atourigny@fitchburgma.gov and
jdavid@fitchburgma.gov. You may also mail the completed form and resume to:
Office of the Mayor
166 Boulder Drive
Fitchburg, MA 01420
ATOURIGNY@FITCHBURGMA.GOV