Application- Fletcher, John PBOT 1-27-12 CITY OF ATLANTIC BEACH
BOARD / COMMITTEE MEMBER APPLICATION FORM
Please check ( '1) 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 Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: ( - 7 7 0 (Z, APPLICANT'S NAME: ; At , it _ - r
ADDRESS: 0 . 1111 -....1! r,,. • • I ... 2:2..._
DAYTIME PHONE: o 9+_ L � j EVENING PHONE: Wit — 6/43. r- 2 Y ( 7
E -MAIL ADDRESS: 1 _ - ���
gu FAX: � - � 403
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P. (L, el, s `./ GC
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 qualifications you have in this field and your reasons
for wishing to be appointed to this board /committee.
*AI 44 1 .1 /` J L ` ... 7_ __J i _ • • - .e _ I _ ./ I' II
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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.
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