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Emerald Hills Safety Enhancement District Board Interest Form
This form has been modified since it was saved. Please review all fields before submitting.
Last Name
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First Name
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District # You Live In.
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Home Address
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City
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State
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Zip Code
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Home Phone
Cell Phone
Email Address
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Owner or Renter
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Number of years as city resident
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Are you registered to vote in Broward County?
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No
Education (highest degree / level)
Occupation
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Work Phone
Business Name
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Business Address
City
State
Zip Code
How many elections have you voted in and when was the last time you voted?
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How many City Commission or board meetings have you attended in the last 2 years? Please list:
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Why do you wish to serve as a member of the Emerald Hills Safety Enhancement District Board?
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If appointed, what specific contribution(s) will you bring to the Emerald Hills Safety Enhancement District Board?
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Please describe your qualifications as an applicant including your professional and/or volunteer experience or background.
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Do you currently serve on any City or County boards or committees? Please list.
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Have you ever served on any City or County advisory boards? Please list.
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List community / civic service involvement.
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I acknowledge that if appointed to serve, I will be required to file the Statement of Financial Interest Disclosure Form 1, as required by Florida Statute 112.314(1)(a).
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Attach Resume (only .doc and .pdf files)
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