Application - Gebeaux, Tracy ARCC 1-27-23 (2) CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(Ai) the box beside each Board or Committee for which you are applying.
❑ Board Member Review Committee(BMRC) 0 Community Development Board(CDB)
VtCultural Arts &Recreation Advisory Committee (CARAC) 0 Environmental Stewardship Committee(ESC)
❑ Pension Board of Trustees (PBOT)—Police 0 Pension Board of Trustees (PBOT) -General
DATE: 14;t4\91 11 2&Z3
APPLICANT'S INFORMATION:
FIRST NAME: 1 RPC\1 ( LAST NAME: EIEBER0(
ADDRESS: 1"� �V Sjt. kLTANIA\C �EACi- , L 32233
CELL PHONE: "1 — c?S\4 —AP-12A- HOME PHONE:
PRECINCT/DISTRICT: E-MAIL ADDRESS: CC C !d\A
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
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Please provide a brief explanation of your interest and your reasons for wishing to be appointed to this
board/committee.
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PLEASE NOTE: This application will expire two (2) years after date of submittal.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
Rev. 2-13-20 Page 1 of 2