Phone Work :        
Home     :               

Place of Employment : 

Job Title : 

We ask your help in assuring diversity of membership by age, gender, and race by answering the following questions:

Sex :    Male        Female   

Ethnic Background:  

 African American           Caucasian          Hispanic         Other         

Physically impaired?      Yes        No       

Date of birth :    

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Please check any of the following Boards / Commissions on which you would like to serve.  If you would like information on what these committees do, contact Town Clerk Jane Jones at (804) 575-4220 or send an email.  

   South Boston Planning Commission

   South Boston Industrial Development Authority

   South Boston - Halifax County Regional Library Board

   Parks & Recreation Advisory Committee

   Transportation Safety Commission

   Halifax County Improvement Council

   Southside Planning District Commission

   South Boston Board of Zoning Appeals

    Lake Country Development Corporation

   Southside Regional Partnership

   Halifax Economic Development Council

   Board of Viewers

   Cornerstone

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Please list any work, volunteer, and/or educational experience you would like to have considered.