Application - Montgomery, Taryn- ESC 1-8-20 - moved from AB per Norris 2-12-21 1.11 1 jr h l Ltil\ 1 ll. DLt1l�II '
BOARD / COMMITTEE MEMBER APPLICATION FORM Pis4 i
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Please check(\i) the box beside each Board or Committee for which you are applying.
❑ Board
Member Review Committee(BMRC)
❑ Community Development Board(CDB)
❑ Cultural Arts&Recreation Advisory Committee(CARAC) tvironmental Stewardship Committee(ESC)
❑ Pension Board of Trustees(PBOT)—Police ❑ Pension Board of Trustees(PBOT)- General
DATE: &/ 2D
APPLICANT'S INFORMATION:
FIRST NAME: --TawLAST NAME: NAM t g 0
ADDRESS: GU��� (JO k- Dmit,
CELL PHONE: Gl()L1' 11\ 0432e HOME PHONE: &Mil
PRECINCT/DISTRICT: E-MAIL ADDRESS: t Vi f e )& CVIQ�otos(('P.Q,fl• ()(
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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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I will be available to interview after 5:00 p.m. on the following date. fr. .. 14 E
September 12, 2019
f" September 18, 2019 JAN 9 2020
Rev. 7-26-19 'age 1 of 3
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Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road,Atlantic Beach, FL 32233
Rev. 7-26-19 Page 2 of 3