Application- Elmore, Kelly CDB 11-13-07 (2)CITY OF ATLANTIC BEACH
- BOARD /COMMITTEE MEMBER APPLICATION FORM 1~~c~:j~.,Fn
Please check (~) beside each Board or Committee that you are applying to serve on: NQV 1 ~ ~~~~
(A summary of each board/committee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
^ Code Enforcement Board I~ Community Development Board
^ Pension Board of Trustees ^ Tree Conservation Board
^ Cultural Arts and Recreation Advisory Committee ^ Board Member Review Committee
APPLICANT'S NAME:
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ADDRESS: ~ 6 ~ (~~G~ ,`1-~~-nv
DAYTIME PHONE: ~~ ~ • Z ~~ • ro Z I ~ ~ PHONE: ~l(I~ ~33. 7~3
E-MAIL ADDRESS: ~i (Wrori° ~, ~~~5~: ~ FAx: `~D~f_-mil - r338Z
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 q~:alificatione you have in this field and your reasons
for wishing to be appointed to this board/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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