AgendaItem2A-BMRC-7-28-05 Putterman, Joshua v CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(v) 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.)
>t Code Enforcement Board /Community Development Board
V Pension Board of Trustees Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: f QS Lk p;,4e101Nel
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ADDRESS: aQ%4 krntnL IC C
DAYTIME PHONE: °/64-3W-44-0S EVENING PHONE: M 2-•?-1)
E-MAIL ADDRESS f414cpu er 01 co c .Att- FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer
expenence relative to gie board/committee applying for
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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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