Application- Coplan, Meade CARAC 3-11-2008CITY OF ATLANTIC BEACH
BOARD/ COiVIlVIITTEE` MEMBER APPLICATION FORM xECEivED
Please check (~ beside each Board or Committee that you aze applying to serve on: MAR 1 1 2fi0~
(A summary of each boazd/committee is available on page 2 of this form.) OFFICE OF THE ctT~ CLERK
^ Code Enforcement Board ^ Community Development Board
0 Pension Board of Trustees ^ Tree. Conservation Board
Cultural Arts and Recreation Advisory Committee ^ Board Member Review Committee
APPLICANT'S NAME: ~ ~ 1= 1~
ADDRESS: l O ~ ~ cS ~-, ~Q
DAYTIME PHONE: ~ ~ ~~'~-- Z (p 8 EVENING PHONE: ~.~
E-MAIL ADDRESS: ~ a c~ FAX: ~ ~ ~'" ?j Io gj~"
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Please explain any employment experience, board/committee experience, andlor community volunteer experience
relative to the boazd/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
fo\r wishing to be appointed to this boazd/committee.
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Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
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