de Carle, Rodney CDB 7-15-05 v CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check(N)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 Communi Development Board
Pension Board of Trustees - ree Conservation Board-
Cultural Arts and Recreation Advisory Committee
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APPLICANTS NAME: RCPA/Ey 1) CfE CA/2LE [)
ADDRESS: 5/ Lit+CN AVOJuE'
DAYTIME PHONE: 24 -OO V EVENING PHONE: 244_"Q
E-MAIL ADDRESS: U t •4e FAX: 247 CC1
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.
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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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