Roskein, Lynne Knecht CARAC 3-12-08
CITY OF ATLANTIC BEACH BOARD COMMITTEE MEMBER APPLICATION FORM Please check the boxbeside each Board or Committee that you are applying to serve on r31 one please raak more than your
interest in each board committee by order ofpriority A summary ofeach cboommaitrtede is available on page 2 ofthis form MAR 1 2 008 Code Enforcement Board Pension Board of CommunityoIjRK
Trustees O Tree Conservation Board di Cultural Arts and Recreation Advisory Committee Board Member Review Committee DATE J ASPPLICANT NAME y ADDRESS DAYTIlVIE PHONE SnMEAIL ADDRESSoSa
EVENING PHONEl3D FAX Please explain any employment experience cboommaitrtede experience aonrdrelative to the cboommaitrtede community volunteer experience applying for C Please provide
a brief explanation ofyour interest or any special qualifications you have in this field and your reasons for wishing to be appointed to this cboommaitrtede r c r n f f Please return
completed form to DonnaL Bussey City Clerk 800 Seminole Road Atlantic Beach FL 32233 PLEASENOTE Ttris application will expire two2 years after date of submittal 1