Jeffery, David L. cdb CITY OF ATLANTIC BEACH
BOARD/ COMMITTEE MEMBER APPLICATION FORM
Please check (�) beside each Board or Committee that you are applying to serve on:
(A summary of each board/committee is available on page 2 of this form.)
❑ Code Enforcement Board C'Community Development Board
❑ Pension Board of Trustees ❑ Tree Conservation Board
❑ Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME:
ADDRESS:
DAYTIME PHONE: EVENING PHONE: ----
E -MAIL ADDRESS: Jqw ' e _ FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer
experience relative to the board/committee applying for.
16-11-1 J' 4 ?c 0 A iW C� G�
Please provide 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.
/ Aq CC,0VC -fZ d-N`7 Zvr ih C s
AAA
C - 7 1, ,41-�L of C. / i) 4 L'zx=w L&A1
f / lam � U /�/7` �[� ( 2ff
7711 1✓& `Ti -/,Q -T �.4.0
Y� T '7yc Z Cl ` --
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
1