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Town of Fort Myers Beach
Advisory Boards and Committees Application
Complete one form for each application/committee appointment. Your application will be a public
record subject to disclosure on request.
Please type or print clearly.
Today’s Date:
Name:
Last First Middle initial
Telephone Number:
Email Address:
Home Address:
Mailing Address
(
if different from home address):
Are you currently serving on any of the Town’s committees? Yes
No
If yes, which committee(s)?
If yes, when is your term expiration?
I am applying for appointment to: (Check one)
Anchorage Advisory Committee
Audit Committee
Bay Oaks Recreational Campus Advisory Board
Community Resource Advisory Board
Cultural and Environmental Learning Center Advisory Board
Local Planning Agency
Marine Resources Task Force
Public Safety Committee
Ha
ve you been convicted of a felony, an offense involving moral turpitude while
in office? Yes No
Do you have unpaid fines or liens due the Town? Yes No
Are you a registered voter within the Town’s jurisdiction? Yes No
