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2. To view Resolution No. 21-16, click the following link:
   Resolution No. 21-16
4. Please check the box beside the Board/Committee for which you are currently serving.*

   1. Board Member Review Committee
   2. Community Development Board
   3. Cultural Arts and Recreation Advisory Committee
   4. Environmental Stewardship Committee

   1. Pension Board of Trustees - Police
   2. Pension Board of Trustees - General
   3. Safety, Traffic and Parking Committee
   4. Charter Review Committee
6. In which position are you currently serving?*

   (Choose one)

   1. Board/Committee Member
   2. Board/Committee Chair
   3. Board/Committee Vice Chair

   1. Board/Committee Secretary
   2. Staff Liaison
8. Date*
   Date
10. First Name*
11. Last Name*
13. Address*
15. Cell Phone*
16. Home Phone*
18. Email Address*
21. Certification of Training Completion and Acknowledgment of Understanding (Pursuant to Resolution No. 21-16)
    I hereby certify that I have completed the mandatory training provided/sponsored by the City of Atlantic Beach and acknowledge understanding of the duties and responsibilities related to the Board/Committee for which I currently serve. 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 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.
23. Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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