Application - Montgomery, Taryn- ESC 1-8-20V., 11 1 V.11' ti 1 1itt1'4 111, 1)L` I -i 111
OA / COMMITTEE MEMBER APPLICATION FORM
Please check (') the box beside each Board or Committee for which you are applying.
❑ Board
Member Review Committee (BMRC)
❑ Community Development Board (CDB)
O Cultural Arts & Recreation Advisory Committee (CARAC) )vironmental Stewardship Committee (ESC)
❑ Pension Board of Trustees (PBOT) — Police 0 Pension Board of Trustees (PBOT) - General
DATE:
6/761-zo
APPLICANT'S INFORMATION:
FIRST NAME: ID Yfl
LAST NAME:
ADDRESS: i�� � �� VG iT I -
CELL PHONE: q UL (A\ 0 2/ HOME PHONE: (sa,s
PRECINCT/DISTRICT:
E-MAIL ADDRESS: 1-7,11e al,(1 q- t 11-1 o(i)
Please explain any employment experience, board/committee experience, and/or community volunteer experience
relative to the board/committee applying for.
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Please provide a brief explanation of your interest and your reasons for wishing to be appointed to this
board/committee.
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I will be available to interview after 5:00 p.m. on the following date.
;M' September 12, 2019
IT September 18, 2019
Rev. 7-26-19
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Please return completed form to
Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233
Rev. 7-26-19 Page 2 of 3