AgendaItem2B- BMRC-7-28-05 de Carle, Rodney 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 rm.)
❑ Code Enforcement Board LCommuniq_Development Board
❑ Pension Board of Trustees _ Tree Conservation Baird-
CI Cultural Arts and Recreation Advisory Committee
APPLICANTS NAME: f�GDA/EY dE C RLt
ADDRESS: 5/ EL:71-0-1 AIEUu6'
DAYTIME PHONE: 2441 -Car EVENING PHONE: 249_46a0
E-MAIL ADDRESS: flA USRtCa/f(nCi.Aei FAX: 247" CGCG
Please explain any employment experience.board/committee experience,and/or community volunteer
experience relative to the boardlcommittee applying for.
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Please 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._
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Please return completed form to
Donna L. Bussey,City Clerk. 800 Seminole Road.Atlantic Beach,FL 32233