CAB Application.

APPLICATION for MEMBERSHIP
to the
COMMUNITY ADVISORY BOARD (CAB)


Name:__________________________

Address:_________________________ Apt. # _________________

City: ___________________________ State: _____ Zip Code: ______ - _____

Member Stats: M or F
Ethnicity: ________________________

Telephone:
(h) (713/409/281) ________________
(w) (713/409/281) ________________
(p) (713/409/281)_________________
e-mail:__________________________
Fax: ___________________________

Other: ________________________________________________________________
Briefly explain why you are interested in becoming a member of the CAB for the Galveston test site:

I, the undersigned, agree that if accepted for membership, I will follow the guidelines as set forth for the CAB, respect membership anonymity, and attend and support CAB efforts.
Signed/Dated: __________________________________________________________

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