Application- Withdrew Application- Eilers, Elizabeth iHDft'J — 1/7/1/7/10
CITY OF ATLANTIC BEACH Rece
BOARD I CO {E MEMBER APPLICATION FORM ived
Please check( the box beside each Board or Committee that you are applying to JAN 1 5 al
one,please rank your interest in each board/committee by order of priority.
Ymg serve on. If you check more than
(A summary of each board/committee is available on page 2 of this form.)
amt.of Ply CMrlt
Code Enforcement Board
✓ Pension Board of Trustees V Community Development Board
Cultural Arts and Recreation Advisory � Tree Conservation Board
visory Committee A Board Member Review Committee
DATE: — 5 APPLICANT'S NAME: -1/2,4i3 T
ADDRESS: '3 6 y T1fixi).
` /-� 7-Z o gc /DAYTVE PHONE: 910 f / �o �
EVENING PHONE:
E-MAIL ADDRESS: FAX:
Please expo any employment experience, boatd/committee e
relative to the board/committee apply' for. xperience, and/or community volunteer experience
i
, AL; Z/6 -4-Aa /VP IrdS .
3b o o,vd Ae r / 6 a uA/1) f
Please provide a brief explanation of your interest or any special qualifications you have in this field
for wishing to be appointed to this board/committee. and Your reasons
4-41, Y-02-0-e //!---P---0e-ge-6,
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.
loym, -/ "Ke..a-0 'No 046