Elmore, Kelly CDB 11-13-07 (2) CITY OF ATLANTIC BEACH
BOARD/ COMMITTEE MEMBER APPLICATION FORM RECEIVED
PIease check (�) beside each Board or Committee that you are applying to serve on: NOV 1 12007
(A summary of each board /committee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
❑ Code Enforcement Board is Community Development Board
❑ Pension Board of Trustees ❑ Tree Conservation Board
❑ Cultural Arts and Recreation Advisory Committee ❑ Board Member Review Committee
APPLICANT'S NAME: re-
ADDRESS: A-\xnv 6
DAYTIME PHONE: 10 j Z I I PHONE:
E -MAIL ADDRESS: FAX:
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 or any special qualification.- 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 Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
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