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CITY OF SOUTH MIAMI BOARD /COMMITTEE APPLICATION
6130 Sunset Drive
South Miami, FL 33143
1. Name:
(Please print)
2. Home Address:
3. Business Address:
Phone No. 305- 663 -6340
Fax No. 305- 663 -6348
4. Home Phone No. Business Phone No.
Fax No.
5. E -mail Address:
6. Education/Degree Earned:
Pertinent Experience:
Field Expertise:
7. Community Service:
8. Attached Resume: ❑ (Optional)
9. Are you a registered voter? Yes _ No
10. Are you a resident of the City? Yes _ No
11. Do you have a business in the City? Yes _ No _
12. Ethnic Origin?
White Non-Hispanic— African American _ Hispanic American_ Other
13. I am interested in serving on the following board(s) /committee(s):
First choice
Third choice
Second choice
Fourth choice
Signature Date
Applicant
TTC APPLICATION O WILL RVAIAIN ON FI Clip _NF VDAD