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ApplicationCity of Concord Historic Preservation Commission Resume Form for Membership to the Historic Preservation Commission (to be filled out by any interested parties) Name: Telephone: Address: My personal residence is located within Concord City limits (yes/no), within the City's extraterritorial jurisdiction (yes/no), or in the unincorporated Cabarrus County territory (yes/no). Please list below your personal, professional, or organizational activities related to historic preservation: (use additional paper if necessary). (These may include the following: restoring or rehabilitating an older house or place of business; involvement in community preservation organizations, historical societies, or other groups working to promote historic preservation, such as appearance commissions, planning boards, arts council, or downtown revitalization committees; involvement in historic preservation as a professional architect, historian, architectural historian, archaeologist, landscape architect, planner, anthropologist, curator, conservationist, or folklorist; or other activities that you believe are related to historic preservation.) Please list any other education (especially if you have degrees in preservation -related fields), skills, training, or experience that you have which you consider advantageous to your work on the preservation commission: (use additional paper if necessary): Have you attended any classes, workshops, or seminars on historic preservation, history, architecture, or archaeology during the past five years? If so, please list them below: I hereby certify that the above provided information is true. I promise that, if appointed. I will work to preserve Concord's historical character and integrity so that present and future generations will continue to benefit from our rich tradition. However, I acknowledge the fact that the completion of this form does not guarantee my appointment to the Concord Historic Preservation Commission. signature Date