AgendaItem2G-BMRC-7-28-05 Sapia, Paul v 14 ' A'-7
CITY OF ATLANTIC BEACH ; r;=,-,ry C[,ERK
BOARD/COMMITTEE MEMBER APPLICATION FORM
Please check(11)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 ' Community Development Board
Pension Board of Trustees _ Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: Rct— N
ADDRESS: 2 J Z 1o' -cp ;'. 5 . 114-L'. *II,. FL 32.13
DAYTIME PHONE: $0,1- 6 51- j L 6 7 EVENING PHONE: y c`I- Z`It- N 3 t
E-MAIL ADDRESS: fP‘,..1 P,.� to•titcti�,-1t� FAX: - Z15 .
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 qualifications you have in this field and
your reasons for wishing to be appointed to this board/committee. T T r
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Please return completed form to
Donna L. Bussey,City Clerk, 800 Seminole Road,Atlantic Beach,FL 32233