Application- Hogan, Glad BMRC, PBOT & CARAC 2-26-12 CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check ( J) 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
a Pension Board of Trustees ( Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE : ea f a le POI 1- APPLICANT' S NAME : G 1-14- 1)
ADDRESS : fC (o4 N Or -Az • , annN inc l,3 email F/ ° 322 3
DAYTIME PHONE : d- 4 7 - 3 7 / S EVENING PHONE : e=3 V 7-37
E-MAIL ADDRESS : 9 lad 7-7-19) ?9-€) y ` ( frn FAX:
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
3G I tits a cin PLtf 1 D As A it4Amitcisrfrivigiti A-ct 01 dYZ ffAtlI4ttc y /S PIA) As A air A)D 0-4.71
t gin OF rite_ act • i/tA' " fl► AL'r( ► • ri000142 ' .9APT wr ! •THis. Co '. . I1- 7-7 ° PS . r , ; e
Or Piss; 00 efou3s -bon D Mnt3E2 � P46 / d i Rmiotocite. foe... fFN/4t1;M'/ A % Ctca lrv / fir la
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.
r�>3 r to &—come / tivc1- u5.) rvrT, ynr eery As /nn AP n/
PtoPe5s 1o6 rni Rios paps i /3jCir/mss I ft-AUe LeAiweo ro READ ?go pt.t WELL-
MTh 10 r /4 MEPi eaMR.- s/ pas f4nn p�.-1 Audi") 4hf1 Olt r
TO TH& ftz: Am) rOeii //Cu in T` Am 4c -1 eir4 --,
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 .
1