Hagist, Juliette CEB, PBOT & CDB 11-30-05
CITY OF ATLANTIC BEACH BOARD /COMMITTEE MEMBER APPLICATION FORM ~ :-:p, Er Please check (-J)beside each Board or Committeethat you are applyingto serve on: (A summary of each board/committee
is available on page 2 of this form.) J"."'~"' IIY"CodeEnforcement Board ~ommunity Development Board ~ension Board of Trustees D Tree Conservation Board D Cultural Arts and Recreation
Advisory Committee ,[:I 3 'J200E CLERK -J{.i/jGff£ II /JGISr I? t3 .fJA/dk -1'£tCt<ftC~ e /Is J DAYTIME PHONE: ~ t./9-c;{g;;l J APPLICANT'S NAME: ADDRESS: Iff). f3cfrj-EVENINGPHONE:
,;{'1'1 ~ q9 83 E-MAIL ADDRESS: FAX: Please explain any employmentexperience,board/committeeexperience,and/or communityvolunteer ~~~~~-~ U-) . ---~ -n ----< ~{:iu1!:!--_~l~~ ~ ?~ ~ ~..
6! ~J ';/-bIPlease provide a brief explanation of your interest or any special qualifications you have in this field and your reasons for wishing to be app~inted ~this board/committee.
Please return completed form to Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, Beach, FL 32233