Application- Daugherty, Jonathan CEB &CDB 3-19-09CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORM
Please check (~l) 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 Tree Conservation Board
Cultural Arts and Recreation Advisory Committee Board Member Review Committee
DATE: I 1 O APPLICANT'S NAME: J d /'~ ~,~ (f 11, e (~
ADDRESS: V ~ v ~T~ '~/ S C lJS S"~r ~ l ~~~~! ~i ~ r~. c G~.
DAYTIME PHONE: /~`l ~ 0 6 D - b ~ ~ EVENING PHONE: .S~ ~t e
E-MAIL ADDRESS: I a m ~ ~" ~Q h~i~-1Gt ~ ~CdN~ FAQ;
Please provide a brief explanation of your interest or any special qualifications you have in this field and your reasons
for wishing to be app ~ ted to this board/committe ~ ~ ~
PLEASE NOTE: This application will expire two (2) years after date of submittal.
1
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach., FL 32233