Exh 5AAGENDA ITEM #SA
OCTOBER 24, 2005
• CCTY O~.ATLANTIC BEACH
BOARDICOMMlTTEE MEMBER lNFO T!O SHEET
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NAME OF BOARDJCOMMITTEEL.~~ i tt1 ~. r
NAME OF APPLI ANTlMEMBER ~`t-~ f~
ADDRESS C~~'l~i.~l--~ i'1 `-~'.TM( ~cCn,} ~~..,.~.-. ~ ~~a~ ~cti,~ iL 7z-~ 7%
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DAYTIME PHONE ! ~`~" ~''~' ~,~ ~ EVENING PHONE ~ ~ 2~~ 1 ~ ~
E-MAIL ADDRESS ~1~~ ~; h ; ~ '~~ t.i Cu , y~" FAX. rK
Please provide a brief explanation of your interest or any. special quaycations you have in this field and your reasons for
vrishing to t)e appointed to this baardlcammittee.
Please. return completed form to
Maureen King, City Cleric, 80Q Seminole Road, Atlantic Beach, FL 32233
AGENDA ITEM #5A
OCTOBER 24, 2005
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NAF~tE OF BOAR
NAtti1E OF APPLI j
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DAYTIME PHONE ~'t D ~ ' ~ QED Zb _ ~~~PNONE ~Q 4~ ~5 3__~_`~-_3 ~ Zj
E-MAIL ADORESS__~(~..l~~.I.rJQ~~r FAX # --~'
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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 boardlcommittee.
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Please return completed form la
h1aureen King, City Clerk, 800,Seminole Road, Atlantic Beach, FL 32233
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ciTY aF aT~ANT~c BEACH
BOARDICOMMi1TEE MEMBER INFORMATION SHEET
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