Application for Appointment as a Member of a District Board
First Name		MI		Last Name
Street Address				Email Address
City, State, Zip				Municipality	Select Town Boonton Boonton Twp Butler Chatham Boro Chatham Twp Chester Boro Chester Twp Denville Dover East Hanover Florham Park Hanover Harding Jefferson Kinnelon Lincoln Park Long Hill Twp Madison Mendham Boro Mendham Twp Mine Hill Montville Morris Plains Morris Twp Morristown Mount Arlington Mount Olive Twp Netcong Parsippany Pequannock Randolph Riverdale Rockaway Boro Rockaway Twp Roxbury Victory Gardens Washington Twp Wharton
How long have you lived in the municipality?				Daytime Phone
Date of Birth
Are you a registered voter?		Yes No		Social Security No.
Have you ever served as an Election Board Worker?			Yes No
Date	_________________________	Signature		___________________________________