AgendaItem2E-BMRC-7-21-05 Pendleton, Ronald v Cr
AUG 1 6 2004
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CITY OF ATLANTIC BEACH _ _
BOARD MEMBER INFORMATION SHEET
NAME OF BOARD ,-.r�teec- - ,c v,i,z,i)
NAME OF APPLICANTIMEMBER -1 ,J,/..a / D�12.cEg=1"d,•.)
ADDRESS /g.Z‘.cd 4• ur- �ial,- ../. -7,-/or ' /','.c"Jf•C ct ren__x `G cre233
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DAYTIME PHONE goy 296 6Q7V1 EVENING PHONE 709 2y' 6 796
E-MAIL ADDRESS'-fes-,)046,'7j 0 W,-te i,Ji FAX# .0/4
Please provide a brief explanation of your interest in this field and your reasons for wishing to be appointed to this
beard.
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Please return completed form to
Maureen King, City Cleric, 800 Seminole Road,Atlantic Beach, FL 32233