[City of Charlotte] ANC Membership Application

Section 1 of 1 in this document

Airport Neighborhood Committee

Membership Application

Cell Phone Number

Work Phone Number

Do you now hold public office?

Yes

Note: Elected officials may attend meetings but cannot serve as members.

If so, what office?

Do you a have any conflicts of interests?

Yes

Note: Possible conflicts of interest could include but are not limited to, working for the Airport or a tenant of the Airport, an individual having a direct financial interest in the Airport or a tenant of the Airport, or an individual having a legal claim against the Airport or a tenant of the Airport. A previously filed noise complaint with the Airport is not a conflict of interest.

Please disclose any possible conflicts of interest below:

Can attend/participate in the bi-monthly meetings in-person at 6:00 – 7:30 PM?

Yes

If you require any special meeting accommodations or have dietary restrictions, please disclose below:

Below, please tell us why you would like to serve on the ANC. Also, please provide any examples or plans for sharing information with your community (e.g., social media, newsletters, neighborhood meetings, etc.).

I acknowledge that I have received a copy of the Charlotte Douglas International Airport Neighborhood Committee Mission Statement and Guidelines and understand the expectations of serving on the committee. My signature below affirms that all of the information provided above is accurate to the best of my knowledge.

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Recaptcha Response

Be sure to verify that you are not a robot by using the Captcha tool at the below.

Full Name

Full Address

Do you now hold public office?

Do you a have any conflicts of interests?

Can attend/participate in the bi-monthly meetings in-person at 6:00 – 7:30 PM?

Sign Here