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2. SELECT THE BOARD OR COMMITTEE YOU ARE APPLYING FOR:
3. Options: *

   1. Environmental Advisory Committee
   2. General Employee Pension Board
   3. Planning and Zoning Board
   4. Public Safety Pension Board
5. PERSONAL INFORMATION:
   (You must be an incorporated Village of Tequesta resident, 18 years of age or order and a registered voter)
7. Name*
9. Address*
11. Email*
13. Home Phone
14. Cell Phone*
16. Business Phone
17. Occupation*
19. Current Employer*
20. Position/Title*
22. RESIDENCY INFORMATION:
24. Length of Residency within the Village of Tequesta *
    (incorporated residents only should apply)
25. Are you a registered voter? *
    (Board membership requires you to be a registered voter)
27. EDUCATION AND SPECIAL INTERESTS:
29. High School
30. College
32. Experience*
    Be specific
34. Special Interests*
36. ORGANIZATION MEMBERSHIP INFORMATION:
38. Are you currently serving on other Boards and Committees (local/county/state)?
39. Response*

    1. Yes
    2. No
41. If yes, which Board or Committee and Describe your Duties:*
43. If yes, how long have you served on the Board/Committee?*
45. List and describe all organization affiliations and positions you have held that would be applicable to your service as a board / committee member.*
47. BASIC RESUME INFORMATION NOT INCLUDED ABOVE:*
49. I certify that the statements I have made on this form are true, complete and accurate to the best of my knowledge.
51. Signature*
    By typing your name above, you are electronically signing the application.
52. Date*
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit Submit and Print

* indicates a required field