Form Center

2. First Name*
4. Last Name*
6. Address*
8. Phone Number*
10. Email Address*
12. Are you a registered voter?

    1. Yes
    2. No
14. Do you reside within the city limits?

    1. Yes
    2. No
16. Present Employer
18. Employer's Address
20. Your Position
22. Professional and / or Civic Activities
24. Education
26. I am interested in serving on (check all that apply):

    1. Board of Adjustment
    2. City Commission
    3. Collinsville Economic Development Authority
    4. Emergency Preparedness Volunteer
    5. Park Board
    6. Personnel Board
    7. Planning Commission
28. Please describe why you would like to serve on this board or committee.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field