Agenda Item 10AAGENDA ITEM # I OA
MAY 14, 2012
CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check (�) the box beside each Board or Committee that you are applying to serve on. If you check more than
one, please rank your interest in each board / committee by order of priority.
(A summary of each board /committee is available on page 2 of this form.)
Code Enforcement Board Community Development Board
Pension Board of Trustees X Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: 4/15/12 APPLICANT'S NAME: Glen Fisher
ADDRESS: 2001 Mipaula Court
DAYTIME PHONE: 904- 246 -9365 EVENING PHONE:
E -MAIL ADDRESS: jagsfish @att.net FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board /committee applying for. Retired in 2010 after 25 years in television broadcasting and 15
years as Senior Sales Executive in charge of Premium Seats and Suites with the Jacksonville Jaguars.
Served as President of the Florida Sportscasters Association, jacksonvilie Buys and Girls Club Sparts all of
Farne, National Kidney Foundation and past soa-rd Member for Selva Norte Homeowners Association
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.
Served on the Board Member Review Committee from 2005 -2010. Was asked to serve again by Mayo
Borno. Have lived in Atlantic Beach for 16 years.
Currently doing volunteer radio show, Doo Wop Revival, every Sunday night for WJCT 89.9 FM
This is without question the most complicated computer doc I have ever worked with. I a looking
forward to someone tell me how they were able to complete in less than two days!
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE This application will expire two (2) years after date of submittal.
AGENDA ITEM # I OA
MAY 14, 2012
CITY OF ATLANTIC BEACH
BOARD/ COMMITTEE MEMBER APPLICATION FORM
Please check (4) the box beside each Board or Committee that you are applying to serve on. If you check more than
one, please rank your interest in each board / committee by order of priority.
(A summary of each board /committee is available on page 2 of this form.)
_ Code Enforcement Board _ Community Development Board
_ Pension Board of Trustees Board Member Review Committee
3 Cultural Arts and Recreation Advisory Committee
DATE: -a a l Of Z- APPLICANT'S NAME: G LA I) "W ^'
ADDRESS: 1 42 4 k i tJKs r 0r_ 172. - h r l f qC Iv , Fl• 3Z -Z-33
DAYTIME PHONE: r�- -Y 7 3t S EVENING PHONE:
E -MAIL ADDRESS C7 /ad 4-7-229 Rj? y da? « '''
Please explain any employment experience, board /commit
relative to the board /committee applying for.
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tee experience, and /or community volunteer experience
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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. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE This application will expire two (2) years after date of submittal.
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AGENDA ITEM # l0A
CITY OF ATLANTIC BEACH MAY 14, 2012
BOARD / COMMITTEE MEMBER APPLICATION FORIVY
FEB - 3 2012
Please check (�) the box beside each Board or Committee that you are applying to serve on. If you check more than
one, please rank your interest in each board / committee by order of priority.. Me or c ity clerk
(A summary of each board /committee is available on page 2 of this form.)
Code Enforcement Board V
Pension Board of Trustees
_ Cultural Arts and Recreation Advisory Committee
Community Development Board
Board Member Review Committee®
DATE: 3 Fib P1Z APPLICANT'S NAME: M ,
ADDRESS: 16o I )—+ —<*,, e,+ A+ "e- Bee-4. r( 32233
DAYTIME PHONE: '14 (oss SZ�a EVENING PHONE: 1 $ (.-I IJ
E-MAIL ADDRESS: I ° �'" •s �`'✓y" FAX: 9 5Z 553 2So!2
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 NOTE This application will expire two (2) years after date of submittal.
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Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233