Application - Beliles, Gregory CDB 1-12-23 (2)CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (\i) the box beside each Board or Committee for which you are applying.
❑ Board Member Review Committee (BMRC)
❑ Cultural Arts & Recreation Advisory Committee (CARAC)
❑ Pension Board of Trustees (PBOT) — Police
DATE: `/ a1 Z3
Community Development Board (CDB)
❑ Environmental Stewardship Committee (ESC)
❑ Pension Board of Trustees (PBOT) - General
APPLICANT'S INFORMATION:
FIRST NAME: Qr o r ACG LAST NAME: ' • I Q S
ADDRESS: LIZ SA )46
CELL PHONE: 7 32- ' B 7 21 HOME PHONE:
PRECINCT/DISTRICT: cNA E-MAIL ADDRESS: Gr.7 , 4{211 C , 3 moo\ . corn
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