Application - Tomson, Bill PBOT 2-8-12CITY OF ATLANTIC BEACH
AGENDA ITEM # I OA
MARCH 12, 2012
BOARD/ COMMITTEE MEMBER APPLICATION FORM
Please check (�) 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.)
_ Code Enforcement Board Community Development Board
Pension Board of Trustees Board Member Review Committee
Cultural Arts and Recreation Advisory Committee
DATE: P L f l a o L 2
ADDRESS:
APPLICANT'S NAME:
DAYTIME PHONE: 70t/ 6 j S-�
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EVENING PHONE: ' / O 1 / x.5,3 e
E -MAIL ADDRESS: &ae �3 erns ,v Gvhsr. . C ,FAX •
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Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
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F ease provide a brief exp anation of ycSur interest or any special qualifications you have 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. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
PLEASE NOTE This application will expire two (2) years after date of submittal.