Item 10AAGENDA ITEM # l0A
SEPTEMBER 24, 2007
CITE' OF ATLANTIC BEACH
~,' BOARD /COMMITTEE MEMBER APPLICATION FORM
_ _
Please check (v`) beside each E3oard or Conlmittce that you are applying to serve on:
(t'1 summarr~• of each board:'committee is available nn page 2 ofthis furor.)
~~ Gode Enforcement E3oard - Community Development Board
~-.Ponsion Board of Trustees : Tree Conservation Board
Cultural Arts and ltecmation Advisory Committee
APPLICANT'S NAME: .''~-~' ~-~' 4' ~- _ ~ ~
ADDRESS: ~ ~ - 1, 4 ~~t- , ~~ ~ 'ti..' •.~, ~'~~ ~ `_
DAY'l'tltiiE PHONE: ~~{ t - `l ~ ~~- ~ EVE;r~°ING FHONE: .~~~~ ~1~~
E-MAIL ADDRESS: ~~ FAX:
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Please explain any employment experience, boardl'committee experience, andr'or community volunteer
experience relative to the board committee applying for.
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Please provide a brief explanation of your interest or any special qualifications you have in this field and
your reasons for wishing, to be appointed to this board/committee.
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Please return completed form to
Donna L. Bussey, City Cterk, 8UQ Seminole Road, Atlantic Beach, FL 32233
AGENDA ITEM # l0A
SEPTEMBER 24, 2007
CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORM
RECEIVED
Please check (~) beside each Board or Committee that you aze applying to serve on: ~U~ ~ 0 2007
(A summary of each boazd/committee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
^ Code Enforcement Board ^ Community Development Board
Pension Board of Trustees ^ Tree Conservation Board
^ Cultural Arts and Recreation Advisory Committee 0 Board Member Review Committee
APPLICANT'S NAME: ~O ~ Y'1 W O ~ ~~°
ADDRESS: ~3S Tn~A-~d W ~
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FL 32233
DAYTIME PHONE: G ~ ~ ~ ~ ~ 7
EVENING PHONE: ~ 9 `f ggg 7
E-MAIL ADDRESS: ~0 ~ h . ~o ~t~'~ ~or+~l'0~7+~~~FAX: .~ ~ ~ q goo
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
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• L;crn:~d Floc;,a ~ra~ Ei~a~e Q~o~*C s~~c~ Zoo.
Please provide a brief explanation of your interest or any special qualifications you hove in this field and your reasons
for wishing to be appointed to this boazd/committee.
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a~~ ~~ S ~~~~O~~eS. Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
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CITY OF ATLANTIC BEACH
AGENDA ITEM # l0A
SEPTEMBER 24, 2007
BOARD I COMMITTEE MEMBER APPLICATION FOxlv1
RECEIVED
Please check (~) beside each Board or Committee that you are applying to serve on:
(A summary of each boazd/comrnittee is available on page 2 of this form.) ~UL ~ R 2007
^ Code Enforcement Board
Pension Board of Trustees
0 Cultural Arts and Recreation Advisory Committee
^ Community DevelopmeritFl~oar~i~lTY CLERK
^ Tree Conservation Board
^ Boazd Member Review Committee
APPLICANT'S NAME: ~ p ~ ST ~= fLN ~ c ~ D
ADDRESS: ZZy 8 i~c~,('e ~~k T f u~.L ~_ ~ ~C'I~wt~jC., ge*~In~ 1'L ~ Z- 2..3.3
DAYTIME PHONE: 2- r7 ~ - S ~ 3 S EVENING PHONE: 2 y ~"" S~ C~
E-MAIL ADDRESS: -~~~ecn~tt2~Y~nl~~nt~ FAX:
Please explain any employment experience, boazd/committee experience, and/or community volunteer experience
relative to the boazd/committee applying for.
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Please pro r:.de a brief explanation of your interest or any special qualifications ycu have in this field and your reasons
for wishing to be appointed to this boazd/comrnittee.
~.S ~clwa -,f~ ~~?c.le: ~ c,J a~S n~-~1- ~~ r : ~ s -f'fri ~ 0~-1- . ~rl- -(ee 1 ~11~„-~
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C ~M~~n: cS s ~~e c ~ (ts-~ Sete ~. YE'~-cS.
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road; Atlantic Beach, FL 32233
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