Application-Parkes, Harleston CDB 11-12-07CITY OF ATLANTIC BEACH
BOARD /COMMITTEE MEMBER APPLICATION F~IVED
Please click (~) beside each Board or Committee that you are applying to serve on: NQV ~ ~ 200
(A summary of each board/committee is available on page 2 of this form.)
OFFICE OF THE CITY CLERK
^ Code Enforcement Board ~ Community Development Board
^ Pension Board of Trustees ^ Tree Conservation Board
^ Cultural Arts and Recreation Advisory Committee ^ Board Member Review Committee
APPLICANT'S NAME:
~S
ADDRESS: l~ ~ g ~ 1~`~QLU ~{~ ~
DAYTIME PHONE: ~,(o'L • (o ~~~ EVENING PHONE: ~~~lJl~
E-MAIL ADDRESS: {`~~i~rLk~~~ C.c}~JIG~C' 1;A~L~ ._---
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for. -~ ~
Please provide a brief explanation of your interest or any special qualif cations you have in this field and your reasons
for wishing to be appointed to this board/committee.
Please return completed form to
Donna L. Bussey, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233