To become a member of the Imagine Kutzky Citizens Council, a letter of interest is required and will be used to submit your nomination to the Council for approval.  This brief application form may also be used in place of a formal letter.

First and last name

Street

City, State, Zip

Phone

Email

Outline the reasons for your interest in becoming a member of the Citizens Council.

(You may copy text from a word processor and paste it into this box.)

Are you able to make monthly meetings, and occasional supplemental meetings when issues arise that may need extra discussion? (Currently, regular meetings are held the first Wednesday evening of each month.)

 Yes

 No

Please list any specific skills or interests you feel you may be able to contribute through your service as an Imagine Kutzky Citizens Council Member.

(You may copy text from a word processor and paste it into this box.)

Would you be willing to become a member of the Kutzky Park Neighborhood Association (KPNA)?

 Yes

 No

 I already am a KPNA member