City of Delray Beach. Board Member Application

Name and DOB
Last Name *
First Name *
Middle Initial
Date of Birth *
Home Address
Home Address *
City *
State *
Zip Code *
Legal Residence (if diferent from Home Address)
Legal Address
City
State
Zip Code
Principal Business Address
Business Address
City
State
Zip Code
Contact Info
Home Phone
Business Phone
Fax
Cell Phone

E-Mail Address *

Board Membership Information
Registered Voter Information *
Professional Certifications *

Interested Board(s) *
Most Recent Employer *

Currently Serving Board(s) *
Your Skills and Knowledge *

Educational Qualifications *
Please Upload Resume *

Advisory Board Information
City of Delray Beach Information *
Educational Experience *

Board Contributions *
Board Advise *

Board Meetings *
City's Vision *

Board Interest *

Please Review and Sign
Please review the information entered in the previous sections before you submit the application. Once submited you won't be able to modify it

Enter your name in the box below then click on submit to send your application


SIGNATURE. *


I hereby certify that all the previous statements are true, and I agree and understand that any misstatement of material facts contained in this application may cause forfeiture upon my part of any appointment I may receive.

Note: This application is a public record and will remain on file in the City Clerk's Office for a period of two years.



* denotes required field