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| *Title: |
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| *Are you a registered voter in the City?: |
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| *Zone: |
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| *Is your primary residence in Daytona Beach?: |
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| *Are you a U.S. citizen?: |
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| *Do you require special accommodations?: |
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| *Do you own property in Daytona Beach?: |
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| *Do you own a business in Daytona Beach?: |
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| *Are you employed in Daytona Beach?: |
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| *Place a check next to the area of special knowledge or expertise applicable to the board opening you are applying for (see listing below).: |
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| *Have you attended one or more meetings of the board for which you are applying?: |
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| *Do you currently serve or have you ever served on a board?: |
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| *Select the board or commission membership of interest: |
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| *I understand the responsibilities associated with being a board member, and I have adequate time to serve if appointed.: |
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