Application- Coplan, Meade CEB 8-7-12 CITY OF ATLANTIC BEACH
to k, 1:11 / COMMITTEE MEMBER APPLICATION FORM
Please check(-V)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
Cultural Arts and Recreation Advisory Committee
DATE: $ —(? APPLICANT'S NAME: Mead/ dio1041
ADDRESS: ID 104, $-4-' A . -K vY Qc€a&z. • C
DAYTIME PHONE: 90q- í,'-- IZ b b EVENING PHONE: 9o1'—z4frfz(0 j
E-MAIL ADDRESS: MIL y 1 l.y / . 0.14 FAX: Gf QL(_ J1(°3 & ?9
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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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