Sapia, Paul CDB 3-14-2005 v RECEIVP'D
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CITY OF ATLANTIC BEACH oirlcE.L,FTNFCITY CLERK
BOARD /COMMITTEE MEMBER APPLICATION FORM
Please check(\)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 C Tree Conservation Board
Cultural Arts and Recreation Advisory Committee
APPLICANT'S NAME: ?ct
ADDRESS: 2 J Z —pG.,�s0 L. 5 . A11 -k," tit Ft. 32Z 31
DAYTIME PHONE: to al' c I CLE 1 EVENING PHONE: y c`I- 2-It-c`I 3
E-MAIL ADDRESS: (k., l. ?t.s�i ce ti�a v4 .tic' FAX: ti G'I- L'5 • ill+S
Please explain any employment experience,board/committee experience.and/or community volunteer
experience relative to the board/committee applying for. aa ff�
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Please provide a brief explanation of your interest or any special qualifications you have in this field and
s our 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