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2. Click link below to view Resolution No. 21-78
   Resolution No. 21-78
4. Click link below to view Resolution No. 21-16
   Resolution No. 21-16
6. In which position are you currently serving?*

   (Choose one)

   1. Committee Member
   2. Committee Chair

   1. Committee Vice Chair
   2. Staff Liaison
8. Date*
   Date
10. First Name*
11. Last Name*
13. Address*
15. Cell Phone*
16. Home Phone*
18. Email Address*
20. Certification of Training Completion and Acknowledgment of Understanding

    I hereby certify that I have completed the requisite training (online) provided by the City of Atlantic Beach and acknowledge understanding of the duties and responsibilities related to the Mayor's Council on Health and Well-Being.  I agree to abide by the principles that were explained in this training. I understand that if I have any questions about the training, materials presented, or information not addressed in the training, or if I encounter any problems, it is my responsibility to seek clarification from the designated staff liaison,  mayor,  and/or city clerk. Your signature below indicates your agreement to the statements above by typing your name in the following box and clicking the submit button.

22. Signature*
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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit Submit and Print

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