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Food Safety Advisory Council Member Application

  1. ccseal00
  2. CRAVEN COUNTY

    HEALTH DEPARTMENT

    ENVIRONMENTAL HEALTH

  3. 2818 Neuse Blvd

    New Bern, NC 28562

    (252) 636-4936


  4. FOOD SAFETY ADVISORY COUNCIL MEMBER APPLICATION

    Food Program Application

     For more information about the Food Safety Advisory Council (FSAC), see our website at cravencountync.gov. Contact Margareta Slagle at (252) 636-4936 if you have any questions or concerns. 

  5. APPLICANT INFORMATION

  6. MEMBERSHIP CATEGORY (SELECT WHICH CATEGORY APPLIES TO YOU)

  7. Owner or manager of a:*
  8. Public:*
  9. CERTIFICATION AND ACKNOWLEDGEMENT

  10. By signing this document, I certify that the above information is provided as true and accurate to the best of my knowledge. I understand that:*
  11. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  13. This field is not part of the form submission.