Application - Beliles, Gregory CDB 1-12-23 CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(Ni) the box beside each Board or Committee for which you are applying.
❑ Board Member Review Committee(BMRC) S Community Development Board(CDB)
❑ Cultural Arts&Recreation Advisory Committee(CARAC) 0 Environmental Stewardship Committee(ESC)
❑ Pension Board of Trustees (PBOT)—Police 0 Pension Board of Trustees(PBOT) -General
DATE: `/ 1 2-i Z3
APPLICANT'S INFORMATION:
FIRST NAME: Qrn 0 r-A �C) LAST NAME: t I.
1l2 S
,
ADDRESS: I Z. 11-1 SA 246
CELL PHONE: 7 32 9 B --7 R 1 HOME PHONE:
PRECINCT/DISTRICT: c ,\ ' E-MAIL ADDRESS: GY-7513 1121 Q 5 mg, 1 . cO(vm
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
US Pr'ni ()kJ-1-k,. U N r,1
TP for .r, /`13c 3t 1rs
r\o\ er TA $00, ,Jj (c,,,„J„,1; A f Ra-fr /I3 S- fs)
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