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Application- Hogan, Glad BMRC, PBOT & CARAC 2-26-12
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 a Pension Board of Trustees 3 Cultural Arts and Recreation Advisory Committee _ Community Development Board Board Member Review Committee DATE: a j aZ- APPLICANT'S NAME: C L -f2" n 1-1-0 6 -ft ADDRESS: I1(p M L t1/4/ s r id 1 -Az •, J i!•/iN -Ft e 7 t?f _N/ Fl 3L-3 DAYTIME PHONE: (4 7 – 37 / S EVENING PHONE: --3Z / S E-MAIL ADDRESS: 9 /ad 7-7--7 » Q litAth) C/»1 FAX: Please explain any employment experience, board/committee experience, and/or community volunteer experience relative to the board/committee applying for. �.S t 1/4712s = einRoLler D ps A itifiPmftcisrIPHAPtiAtt, 6j2. fflAQmtx=y Is P_UIV As 1,-) t NW fe.)QEer Ag-ot O F I'll- eofzf"o2P7/01q, ` m U L it -60_14 Kb 170001 -VE !h H 10'1 Wm.! N 'T/tf5E CO/zft) r r 8 PS. Or Al15s,o) tfoUsg / BoARD Mo4It3F2 (PABA© , t eoNsi?L- X62. FioriAxf A% crCUPi'7/ t` 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. f,)/}p.r tO `8 vme /A OI -UE/) Gut Th Yi1y (73i. /9S /9)2r p /t5/ haVre. s/air/ Spaws,A3,&ir/FS - f-1--,4 OE Le/4,210et Akm 70 EE /4 Mei) AMR.- FOIL All S/ DES, .T /am TD 7741,0K Am) rcerO /le'u In` r , oc-AE/2 — TO READ pg0PL.E WELL. — Aviv fJT/t« (ori 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. 1