Application-Fisher, Glen BMRC 3-2-09 NeAlthirIXat
CITY OF ATLANTIC BEACH On 3/210q
BOARD / COMMITTEE MEMBER APPLICATION FORM
RECEIVED
F ° 1A "6
Please check (1)beside each Board or Committee that you are applying to serve on:
(A summary of each board/committee is available on page 2 of this form.) �FPtGE��E`EEIEy C,1 t Y CLERK
Code Enforcement Board Cpmmunity Development Board
Pension Board of Trustees , Tree Conservafion Board
Cultural Arts and Recreation Advisory Committee P &-d Menther /2 vied c°"'`"`
APPLICANT'S NAME ( 7/ .A/ / S// '/<
ADDRESS: ZfZ�/ 7/6f it CSI
DAYTIME PHONE: (P3;7-- EVENING PHONE: Z
4v�
E-MAIL ADDRESS: f L lj 3— 33'�
jaoff-1-'t(),(, c?'") C./NI/ ne./4-
Please explain any employment experience, board/committee experience, and/or community volunteer
experience relative to the board/committee applying for.
VISM arC ie 47n 4W"�d tS .0 / w/�
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.
4 P-11 &q 2S% -G/ 17 ' a
,eve e-t 4-/T - `r•
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
1