Application- Stinson, John M. CEB & BMRC 2-3-12CITY OF ATLANTIC BEACH Received
BOARD COMMITTEE MEMBER APPLICATION FORM
FEB 3 2012
Please check I 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 Office or City Clerk
Code Enforcement Board Community Development Board
Pension Board of Trustees Board Member Review Committe
Cultural Arts and Recreation Advisory Committee
DATE 3 Fth ZIZ APPLICANTS NAME JOhn YYi S4ir tit
ADDRESS 15 1 Lk fie 14lowvitc F3taa Ft 32233
DAYTIME PHONE GI I Orr Sab EVENING PHONE y g53 421 6
EMAIL ADDRESS Jbj 115 e4VJ 44 k FAX 83 2 55 3 2S19
Please explain any employment experience board committee experience and or community volunteer experience
relative to the boardcommittee 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 boardcommittee
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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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