Raube, Ed for CEB BMRC Agenda 10-20-2004 Item 2A v 1%4
CITY OF ATLANTIC BEACH
BOARD/COMMITTE MEMBER INFORMA
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NAME OF BOARD/COMMITTE L, '.W1Un%t' 1_VEva c " f)^
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NAME OF APPLI ANTNEMBER
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ADDRESS ; ] V -1' �'."( 46314-1 x- L ;c�, l L 5-1.t 17'
DAYTIME PHONE 164 14 4111, EVENING PHONE -1 -I-4(P 1 Li'71
E-MAIL ADDRESS L�Lr4"h` O 'l i u dd. c‘1"^- FAX*
Please provide a bnef 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
Please return completed form to
Maureen King. City Clerk, 800 Seminole Road,Atlantic Beach. FL 32233