[City of Charlotte] ANC Member Application

Airport Neighborhood Committee

Membership Application

Cell Phone Number

Work Phone Number

Do you now hold public office?

Yes

If so, what office?

Do you a have any conflict of interests?

Yes

NOTE: Possible conflict of interests could include an individual serving as an elective official, working for the Airport or a tenant of the Airport, an individual having a directing 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 interests.

Please disclose any possible conflicts of interests below:

Can attend/participate in the bi-monthly meetings in-person or virtually 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.). Lastly, please share any community forums or activities you support.

I acknowledge that I have received a copy of the Charlotte Douglas International Airport Neighborhood Committee Mission Statement and Guidelines and understand that 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

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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.