application- Smith, Jim CDB & BMRC 11-13-07 Do not use - supercededCITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION FORN~
' ECEIVED
Please check (~) beside each Board or Committee that you are applying to serve on: ~~dv ~ 3 2~~~
(A summary of each board/committee is available on page 2 of this form.)
C~FF!CF OF THE CITY CLEKK
^ Code Enforcement Board f~ Community Development Board
^ Pension Board of Trustees ^ Tree Conservation Board
^ Cultural Arts and Recreation Advisory Committee ~ Board Member Review Committee
APPLICANT'S NAME: ~ 1 ~I S~~ ( ~ (-~
ADDRESS: ~ .3 C~ ~. ~~ n- S t t~ ~ E7~2 - l~ ~ L • `~ C ~`~
DAYTIME PHONE: Z `-C~ ~ S~ o v EVENING PHONE: Sv 1- l l ~ y
E-MAIL ADDRESS: J ~ ~ ~~' ~°N'cUi'c'c~~-~ E' .~~ ~-~' FAX: Z ~ G- ,~ 7 ~o
Please explain any employment experience, board committee experience, and/or community volunteer experience
relative to the board committee applying for.
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(~~~C..~` ~~ C~i`'c`'Lc~t2 - f~~~.~~lv~~ G-LL .S~f~~IZa~=rS Gi~C~ -r~~S~~2ti~ O~~?
Please provide a brief explanation of your interest or any special qualifications you ha•.~e 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