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Home My WebLink Aboutcls_agendapkt_2018927i CULTURE AND LEISURE SERVICES BOARD REGULAR MEETING CAPE CANAVERAL CITY HALL 100 POLK AVE SEPTEMBER 27, 2018 5:30 P.M. AGENDA CALL TO ORDER: ROLL CALL: PUBLIC PARTICIPATION: Any member of the public may address any items that do not appear on the agenda and any agenda item that is listed on the agenda for final official action by the Culture and Leisure Services Board excluding public hearing items which are heard at the public hearing portion of the meeting, ministerial items (e.g., approval of agenda, minutes, information items) and quasi-judicial or emergency items. Citizens are encouraged to limit their comments to three (3) minutes. The Culture and Leisure Services Board will not take any action under the "Public Participation" section of the agenda. The Culture and Leisure Services Board may schedule items not on the agenda as regular items and act upon them in the future. ACTION/DISCUSSION ITEMS: 5: 45 p.m. 6: 30 p.m. 1. Approval of Meeting Minutes — August 2, 2018 2. Staff Report — QUESTIONS & COMMENTS ONLY 3. Old Business • Presentation of vacating member' s certificates and service award. 4. New Business FRDAP Grant: Canaveral City Park Redevelopment Project Phase II — Splash Pad Board applicant interviews (alphabetical order): 1. Timothy Bass 2. Tony Divito 3. Michael Dudek ADJOURNMENT: 4. Larry Holmes 5. Kathryn Parks Pursuant to Section 286-0105, Florida Statutes, the City hereby advises the public that: If a person decides to appeal any decision made by the Culture and Leisure Services Board with respect to any matter considered at this meeting, that person will need a record of the proceedings, and for such purpose that person may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the appeal is to be based. This notice does not constitute consent by the City for the introduction or admission into evidence of otherwise inadmissible or irrelevant evidence, nor does it authorize challenges or appeals not otherwise allowed by law. In accordance with the Americans with Disabilities Act: all interested parties may attend this Public Meeting. The facility is accessible to the physically handicapped. Persons with disabilities needing assistance to participate in the proceedings should contact Molly Thomas, City of Cape Canaveral Leisure Services (868-1226) 48 hours in advance of the meeting. CULTURE AND LEISURE SERVICES BOARD MEETING MINUTES AUGUST 2, 2018 A meeting of the Culture and Leisure Services Board was held on August 2, 2018, at Cape Canaveral City Hall, 100 Polk Avenue, Cape Canaveral, Florida. The meeting was called to order at 5:30 p.m. by Chairperson Gene Petre. The Secretary called the roll. MEMBERS PRESENT Gene Petre Barry Schoenholz Maureen Michel Marlene Woodside Mickie Kellum MEMBERS ABSENT Douglas Raymond John Datillo Chairperson Vice Chairperson OTHERS PRESENT Molly Thomas Board Secretary — Cultural Programs Manager ACTION/DISCUSSION ITEMS: Approval of Meeting Minutes of Mav 31, 2018 Motion by Ms. Kellum to approve meeting minutes of August 2, 2018 as written —seconded by Ms. Michel. Vote on the motion carried unanimously. OLD BUSINESS: • Ms. Woodside inquired about the CAPE Center and Multigenerational Facility designs. • Ms. Kellum briefed board on the Community Garden and Little Free Library program. NEW BUSINESS: • Mr. Petre inquired about the expiration of board member terms. • Ms. Thomas confirmed those to expire as Mr. Petre, Ms. Woodside and Mr. Shoenholz. ADJORNMENT: There being no further business, Ms. Woodside made a motion to adjourn —seconded by Ms. Michel. Vote on the motion carried unanimously and the meeting adjourned at 5:47 p.m. Approved on this day of , 2018. Gene Petre, Chairperson Molly Thomas, Board Secretary ii �1 noun 111111111111111111111111111000008 OMIr�' ^lIII MAM MO KM 1‘ VOIM evleuOM 1�d Van WM ITIEN KM,M$ �MNIUS MINK K ma tome awirruu naome �ry`14I CAPE CANAVERAL CULTURE AND LEISURE SERVICES ADVISORY BOARD STAFF REPORT SEPTEMBER 27, 2018 Copied from Weekly Updates 5-10-18 through 9-14-18 No update 9-07-18 Director Meetings & Updates City Manager Diversity Awareness Training • Architects RZK, Inc. • HR Director • Recreation Leader Interview • Exercise Equipment Representative Active Shooter Training Economic Development Director Special Events • DCF Webinar • Supervisor of Elections • City Council • Hurricane preparedness • BCSO re: vandalism • Nuisance trapper • OEEC re: SCAF Advisory board applicant Friday Fest—The August and September events both managed to escape the seemingly daily thunderstorm activity —enjoying beautiful weather and attracting fantastic crowds! September's event welcomed new vendors, new food trucks and a new band. The next event will be October 5 and will feature live music provided by Picture Show. Beer and wine sales will benefit Cape Canaveral Youth Programs and volunteers are needed! Those available to lend a hand should contact Aaron Leyte at 321-868-1226. Street Eats on Taylor Ave —The next Street Eats event will take place Saturday, November 10 from 6:00 to 8:00 PM. Taylor Avenue will be closed between the Nancy Hanson Recreation Complex and the Sheriff's Office parking lot and the event will feature five gourmet food trucks and Bavarian style seating. 2018 Reindeer Run and Holiday Beach Series —Registration is open for the 2018 Holiday Beach Series Run. All proceeds support local youth organizations, with the Reindeer Run supporting our local BCSO PAL program. This is an awesome morning and we encourage everyone to participate. This year, all participants in the series receive a one of a kind medal designed by local world renowned artist Rick Piper. Only 200 of these medals were produced, so don't miss out on your chance to own this great piece of art. Registration Open for 3rd Annual Trunk or Treat — Registration is now open for the City's 3rd annual Trunk or Treat event on Friday, October 26, 2018. Held in conjunction with the Monster Mash dance party, this is the premier Halloween happening for more than 200 local families. This is a non-commercial event where participants are invited to decorate a vehicle and hand out candy to trick -or -treaters. It is also a great outreach opportunity for city officials, residents, condo associations, local businesses and non -profits to engage with our local residents in a fun, family -oriented atmosphere. To add to the excitement this year, prizes will be awarded for best decorated vehicles in lst, 2nd and 3rd place as determined by the most discerning judges around the kids! There is no charge to participate, but space is limited to the first 20 vehicles that register. For more information contact the Culture and Leisure Services Department at 321-868-1226. Back to School Jam— It was another outstanding year for this event! More than 200 Cape View Elementary Students received the supplies they needed to start their school year right! With the assistance of our BCSO P.A.L. Volunteers and the overwhelming generosity of VFW Post #10131 and its Auxiliary, each bag was packed with grade specific school supplies for students in kindergarten through sixth grade. Volunteers were on hand at Cape View's open registration day today to help distribute the bags. ))) Iiliquuu� r�f�i�yur ,116 ��""111"'I iiiii;"l i1i° a Ii1 ,i.vr it uwUprra�,��lrr��lab�lry uiuiw T TRUNK OR TREAT 1l6(r 1s1 fq SI {;G;� rrS71I Friday, October 26, 2018 Nancy Hanson Recreation Complex e' Taylor Avenue 6:30-8:30 PM BEST DECORATED VEHICLE CONTEST — KID S' CHOICE! • NO REGISTRATION FEE! • Prtzes for 1st, 2nd *3rd Place • Residents • Condo Associations col Businesses u -'% • Social vrgonlzadens * Nonprofits 1°1 SPACE LIMITED!! PREREGISII,Tr IRATION REQUIRED! ��UI� i��"'„��jl�b'✓� f�..�W ltl4� UI �iI ��a0u�� '1'1' PI;�stags. day f1tr I) .ill O V01)�) .ram ;1... kV 11110111111 1IIIll1711 Fido Field Day —The 2nd annual Fido Field Day was a huge success! This year's event focused on encouraging the benefits of behavioral training and healthy exercise. It also showcased the many local rescue organizations that offer adoption and placement services. While the addition of the lure course was a huge hit and its proceeds benefitted the Central Brevard Humane Society, the highlight of the day was the races. Staff received a great deal of positive feedback throughout the event and there were smiles and tail wagging everywhere you looked. It was a beautiful day in the park and a great way to celebrate National Dog Day! The plan for next year is to have the event later in the fall as August is still quite hot in our area for some of our furry friends. The second week in November 2019 is part of National Pet Shelter Appreciation Week and National Pet Awareness Month, so mark your calendars for November 9, 2019! y uu m w omii i1a» ^^um 11111111 1N u jjininhu 1111111' Athletic Leagues [ACQUETBALLLEACUL ��yy7 Ilk og, CAPE CANAVERAL. Registration for next season's advanced racquetball league is currently open. The existing season is nearing the playoff tournament, in which the top eight seeds will take the court and battle to become the league champion. Kickball is nearing the end of the regular season and teams are fighting to make the playoffs. There are two teams that are currently undefeated this season, Graham's and W.S., who will play each other this week for the top spot in the league. The Cape Canaveral Co -Ed Softball League wrapped up its season with J.F. claiming the championship! Congratulations and thanks to all the teams that helped make this another successful season! The next season is scheduled to begin on September 20, 2018. The Cape Canaveral tennis courts are staying extremely busy with three City leagues that take place each week and the Space Coast Tennis League. The City leagues are held on Mondays, Wednesdays and Thursday evenings, and Staff is always registering new players. For more information, please call Recreation Coordinator Aaron Leyte at (321) 868-1226. A new Space Coast Tennis League season started Thursday with the home team, The Island Girlz playing at home in Cape Canaveral; we wish them much success and hope they bring the championship back home where it belongs. 11000 111110111110000000000011111111111101011111111111111111011111111 11.1111114 00000000001111111101111111111111 01111.11111111111111111111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 010011111111 Programs Summer Camp —Now that the Cape Canaveral summer camp has come to an end, let's do a quick recap of all the fun that we had this summer! During the 10 week program, campers enjoyed field trips to the Cocoa Beach Aquatic Center, Cape Canaveral Fire Station, Cape Canaveral Library, and also welcomed many visitors that brought their activities to us. This summer we had groups such as RC1 Hobbies, NASA Launch Services Program, University of Florida IFAS nutrition program, BCSO's K9 unit, and Brady's Bouncers who visited camp and brought one of a kind activities for campers. During week 10, summer camp launched the rockets that they built earlier in the summer. On Friday, all campers who attended camp this summer were invited to the end of summer party. We had Brady's Bouncers provide inflatable bounce houses and obstacle courses and ended the summer with a pizza party! A big thank you to all the parents that trusted Staff with their children, above mentioned partners and hardworking Staff who provided a great experience for all who attended. MINSI 'illl1l11k 11,11,1111 11111111111111111111111111111111111111111, Il0 a uu uul ouuu��tihludllh nnluou IP�i��IV�k�kmlii�l 1111111111111n, ��,,,,, V ��II�!� 1 0 ,, lllluuuuuomuuomww pp r � III �I�IVI��uu��litmured�muulmm�lmu, gym' pgrIMIWAWMplIPpooe Aikido Class Honored by Visit fromAAFPresident—One of the City's newest recreation programs received quite an honor last Friday's as instructor Sensei Johnson welcomed his teacher, Sensei Michael Moreno Shihan, as a guest instructor for their class. Sensei Shihan was mentored by Kisshomaru Ueshiba, the son of the founder of the Aikido discipline, and was a direct student of two other very famous Aikido Masters, Sadatetu Arikawa and Masatake Fujita. The students were impressed by Sensei Shihan's mastery of the art and were honored to have had an opportunity to learn from him. looll000tovoi �iw�6lllrlsirrl I Cape Canaveral PAL Kid Grows Up & Gives Back —Max Trapasso, a resident of Cape Canaveral who attended Cape View Elementary and Cocoa Beach Jr/Sr High became involved with the Brevard County Sheriff's Office Police Athletic League — Youth Directors Council when he was just twelve years old. Max volunteered endless hours for the City of Cape Canaveral during his six years with the YDC/PAL program and also worked as a Summer Recreation Leader for the City Summer Camp. Because of his tremendous involvement with the PAL organization, at both local and state levels, Max was appointed as chairperson for the State Florida PAL annual conference. He was a recipient of the Tomorrows Team Scholarship Award of $1000.00 and in 2015 was recognized as PAL's Boy of the Year, receiving both a computer and another $1000.00 scholarship. Max is currently a senior attending Rosen College of Hospitality Management majoring in Entertainment. He also works at Universal Orlando as a Relief Lead on the Dr. Doom ride where he supervises nearly 60 employees. The PAL program has meant a lot to Max, much more than words can express! In 2015, Max initiated the Max Trapasso Scholarship Award as a way of showing his appreciation for the organization that helped him become the leader he is today. Every year Max gathers applications from PAL kids across the state, that write an essay titled What PAL Means to You. Max presents the winner of this essay contest with a $500.00 check at the annual State Florida PAL Conference in Orlando. This year's recipient was Tiara Glenn from Ormond Beach PAL. r..11.,..7"..,...Ir,...r...— I 01011 �" n �r`rtluuuurer. We are so proud of Max, a true leader who leads by example! RlI v IIljl�uu"i Buliiiiiiiiiiiili NGi', uu 'fl I1u11quuuuuuulu Parks & Facilities City Parks = Quality of Life + Economic Impact —A Cape Canaveral resident chose Banana River Park as the place to make a lifelong memory. As neither he nor his new wife were born or raised in the City, they could have chosen anywhere in the world to celebrate their nuptials. But after visiting our park they decided Cape Canaveral was it! Their guests, who all stayed and dined locally, flew in from as far as Russia to attend. Although the weather was far from perfect, everyone had a wonderful visit and remarked on the beautiful setting. Without a doubt, this small pavilion not only helped create a sense of place for this happy couple and contributed to their quality of life, but in doing so, made a quantifiable economic impact on the City. ,,111111111111111111111., t New Additions to Manatee Sanctuary Park The baby Manatee has been reunited with its parent. If you want to see a real cast of a baby Manatee, stop by the park and check it out. The contest to name the new addition ended with a vote during the Fido Field Day event. Thank you to everyone that participated and voted or provided names. Drumroll please... The winning name for the baby manatee at Manatee Sanctuary Park is Rocket! Here's to Rocket making a big difference encouraging Eco diversity, conservation and stewardship of our Indian River Lagoon. '1 II Ill II 111111111111111111111111111111 I�i111I;1j�I�I��hhtii4PII�V��lipi� � ��n A pair of alligator siblings have also found a new home at the Park. Since most of the public bike racks were taken up by the most successful bike share program in Brevard County, Infrastructure Maintenance cleared/prepped the area and poured new slabs for the siblings. It's a family affair at the Park. Old Youth Center Building —Preparations have begun for demolition of the Old Youth Center. An already used doublewide trailer donated to the City in May of 1996, it opened its doors for service on September 16 of the same year. Fun History Facts: Before taking possession of the trailer, a special exemption had to take place in order to allow the installation of a manufactured building within the R2 district, with then Mayor John Porter suggesting the trailer could serve as a police substation. The trailer served a small need discussed at a council meeting which took place in 1995, where Mayor John Porter introduced the idea of bringing a YMCA to the City in lieu of a City owned facility, with then Council Member Leo Nicholas requesting the idea be "expanded to civic center to include senior citizens", thus the seed for a Multigenerational Facility was planted over 23 years ago. The trailer served as the home of BC SO PAL, the City's summer camp program and afterschool safe haven for children ages 10 through 15 years old. Water and electric have been capped with demolition taking place once all permits have been completed. / �I IVVV 41��d1,1 A1111ioioioiNouuuuuuuuum ppu #41.1W1„u „'u Inoonolooloolomoq m III 40 m. Elections at Nancy Hanson Recreation Complex —Patriotism was very evident on Tuesday as 725 people voted at the Nancy Hanson Recreation Complex. The City worked with the Supervisor of Elections office to provide an alternate voting site after they received news that Cape View Elementary was no longer a possible site. Staff poured small connecting sidewalks, trimmed hedges and did everything necessary to ensure a smooth experience for our residents. Congratulations to the winners and we hope they make decisions that positively impact all of us. Vandalism Repaired at Center Street Park —This week, Staff received a report of vehicular damage to the fence and bike rack at Center Street Park. The incident was reported to the Brevard County Sheriff's Office and the damaged features were removed from the park. Repairs will be completed by the end of the week. If you have any information regarding this incident please contact the Brevard County Sheriff's Office at 321-633-7162. Cultural Programs Cultural Programs Manager Assists FPAN with Conservation Program —On Saturday, the City' s Cultural Programs Manager assisted staff from the Florida Public Archaeology Network' s (FPAN) East Central Region in teaching a Cemetery Resource Protection Training (CRPT) course at a historic cemetery in Titusville. CRPT is a public outreach program that offers instruction on the best practices for historic and not -yet historic cemetery preservation, as well as the legalities for respecting burials and human remains. As the chairperson for the Brevard County Historical Commission, Ms. Thomas was approached by a local veteran' s organization, Friends of the Cemetery, requesting help in conserving the Titusville Veteran's Cemetery as well as the adjacent, County owned, pauper's cemetery. Recognizing this as an educational outreach opportunity, Ms. Thomas put the organization in touch with FPAN and, with her experience in the field, offered to assist with the class. Twenty students attended this course, including a local Eagle Scout, who will be using his CRPT Certificate to initiate a community service project that will document, clean and establish a long-term conservation plan for the properties. These courses are held throughout the state and throughout the year by the different FPAN regional offices and the East Central office hopes to host another class in south Brevard this fall. For more information on FPAN and its many programs, visit http://www.fpan.us y t� 14�10 9�I� w Cape Canaveral Announced as New Home of Irma Canoe Well, the cat's out of the bag! The City of Cape Canaveral is proud to announce that the Florida Division of Historical Resources has selected the City to be the home of the widely publicized and invariably intriguing, Irma Canoe. 3d o 44ff)IJRYDA0 LLPY£MD0R I7,Z Ole a rl0w'9IDA TODAY Daily Digest Cape to display mystery canoe from Irma Rick NE,,,throno mow opokomonian. oeo h t dinow Reven has offered a the inyaory red in theSunshine few *pot..., poehops d: WI '`V r SI to Oh,. inly othe, that thde One 7 r ago, H book the rnth t sq A tt FR.. rthasion loom an old t 1 in the Mt illias Eleoce waves woodenboat? And ~•ti w f fl t 1 'a IRO 1 Arlo w 1 d1 a a y h tl m w1 p m Id b cr., oarme was eradethe clogerat canoe ontoInd9 r Rev. Erni,. h. a ' R b y in d d A h B I p d �tlt e - - PI u9 t 1 0 t fa, 1yea A �' Du';J � +�" A l Porn., . N 1 y y d ' ,o1l lhf yl struck. q t rcl mil , .,t.;mm;mrvih Iyl, a iGH G1�ttf✓ASV/�4(d%lea Am y g' tmodified tl e craft likely ..1' Ik ill y' t 41 i11 an�t Th clyuut washed t knd River Drive in A011 Romp.. built daring .aild t the rest tines In 'Rom u VI V back t' Cacca when ltuarivuave .ma k.a„uxaaT m. Nawer nd4 1. e¢nlers the 1P29 'Ytt g1 he a :. the Sy Coast, The1 barn non., odds utl 'n"e theory are tt ioculenn gating tox'c,c n w'u ER Can ddv- ors .�n�,ww nvaxnlue centuries View. ha,.ha,.ulotormVnadd there is a plployotortinp Sept. 28 on Lathr0,p sttumbled. Last (:all, tlnlvers,1y of 50 p.c.. p.[00ability the,,gammundty artifacts ugy cate,'Ites. .up. That', p.i11. wpan the eon. vwinka hi- SOtoth Florida Li1i'uries II ,agates beltbeltween room at Cape Canaveral pool of 'tlh. ',the city of Capse, Ca cycling on Sept 41, 201"1, orootkll a 117 image 0201 1014 t,,WOO --making 01190 91excited to have 't and novo,. wlh thke pc,_sas- along 1,r,lian Hive: Drive puterEyendering of Ihe cia, at loam an,yar, Id. 'V see 11 as pt t 1 lop11w'.Nr d Thom.. Moutortt'm-N 01,4 north ofStte..,h, d noe, And a 01,] 'lyof 'thow -v a 3/,2 pen.. Technology itornoWng so nw who al. et1nla0 the 7 1 h61e loan, 'Moms s Sdhe shortly alt. 1 nous 7enner ee YCW2 0119t probabiRty the canon fa. wht the Racvani Colony V. .d id.'rho log b at will,e- winds 80Ilsy.0 has onsuccessrolly a, dates botwOon 1760 ➢11 1 datmg inethuis CAc and d;lfty a.the Compounding the tempted tt' the 11918, with an 8.6 pecom, that rue d inore....A wokome event be owonamily artifal.mystery, Lathrop noted canoe, ageYdnr- pr h k ty that itd ogy said Molly 11 gin, nx a4 A pot Sop. 28 room kintHR,OV,,,i the foRto rod cluwhoniVIOgy. w wooly- 1930we lvv.l'eh Cape c, semi 2'u,ilul^a1 with presentations by P. t9w old tape Carlave44V sway, htad,d,ron naiBs.>' 1 of a amotual N. Mt.,- to n I y. program managerw, 1 oophoWROthWY Ixx and t ly li ll t I.0 . i s0V h. t p ,V growthri 11 no., - B f t a w ethesluglu wr don't,1 pd 12or - Ron- p I l /41AQ 1 t paint, p nl 444,M10 Nettie pl 921- cl ctonmlu rrdnd IN d hand c,YY they road. dy 00, Lathrop, ?0 Um,. l the wVv 1,2 o d ovid 241-:3G38 S d f f d d l d 1 II y d d, i t} nowt llrtre drvrB mancntl the d I 'rinmar or a vriteCflwnalata- ' h fb.veVl, B'lanlda l o holy A ntootie d the e i5,11 t pens to the. dhrcMa II1w0 an U,41. Eta may rluy rotte1 p ' dWnY M' 61nte now bolt. the toothed,p.1'r71c Para yid m_to fi_11l Maw pcd.hd- . it cn- I,mt, lnccn amached lred ]uut[er {,00tekfealcl A year ago this week, a storm surge created by Hurricane Irma dislodged a historic canoe from its watery resting place somewhere in the Indian River, and deposited it along Indian River Road just north of Cocoa Village. It was discovered the next morning by a local resident and photographer, Randy "Shots" Lathrop who recognized g its significance and promptly reported the find to authorities at the Florida Division of Historical Resources. The City's Cultural Programs Manager was on hand a few weeks later to help staff from the Florida Bureau of Archaeological Resources retrieve the canoe for conservation and analysis in Tallahassee. After discovering that City was the process of constructing a new cultural facility, the collection managers from the Division of Historical Resources reached out to the City's Cultural Programs Manager offering the Irma Canoe on indefinite loan for the City to exhibit in the future Culture Arts Preservation and Enrichment (CAPE) Center. Mystery canoe uncovered after Hurricane Irma getting its own exhibit Canoe won't be a mystery forever, Cape Canaveral staff historian says. doeffit f 100001011,00lU(Y!!!(�IIIIIIIIIIhPK(@UI'IUI'IUIY iIM�h,:nld (JAPE CANAVERALIFIla.- Oommbor carn.thothow i,4444,14 I'n21.44141'4 .n111'41eI dl 11 eiidat [owl,E tld'ld y, ' p.Ci'g'1,awi'1 Jv1201, c 0000 ooero,1 e the 'd'du:i fat dn: the cad01010]i. whato ea Eon, know.wo, v^hr;„dfill Cape Canaveral to open exhibit for Irma canoe Y] WBpint,i CAPE CA'AAVERAIL. IIA.. (W 0E1 REX EEL Tit' PICelda Dna., mH hi, 00yoCa.'a n,el to de Ow Room of tr'im"+rc+,aly p0'ulp1„w,d lona Cow.' The canoe's conservation process did not take as long as originally anticipated, and since the City's Community Artifacts Room could accommodate it, a temporary installation was arranged to showcase the artifact until the CAPE Center is complete. To commemorate its arrival, a welcome event will be held City Hall, located at 100 Polk Avenue, beginning at 4:00 pm on Friday, September 28, 2018 and will feature presentations by archaeologists from Paleo West Archaeology, as well as the canoe's finder and renowned photographer, Mr. Randy "Shots" Lathrop. Following the presentations, the exhibit will be opened to the public from 5:00 — 6:30 pm. This interim exhibit will be open to the public Monday — Friday from 8:30 a.m. — 5:00 p.m. throughout the month of October. Staff will then evaluate the visitor demand and adjust the exhibition times as needed. For more information contact the Culture & Leisure Services Department at (321) 868-1226. e oard ember Interview 1 uestions 1. Could you please tell us about yourself 2. Why are you interested in serving on the Culture & Leisure Services Advisory Board 3. Do you have any experience serving / working with advisory boards 4. Have you ever attended any City organized events, which one is your favorite? 5. Which is your favorite City Park, why? 6. Board Member Choice. CITY OF CAPE CANAVER IL APPLICATION FOR APPOINT ENT TO CITY ADVISORY GAR R CGMTTEE Pursuant to Section 2-171, Cap Canaveral Code City Code requires prospective and existing board rnembers to fill out an application, City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony, unless their civil rights have been restored. Pease complete the following in the space provided: A. GENE `'1 -.I 1. Applicant Name: 2. Home Address: 3. Home and Cellular Telephone. 4. Occupation: CI V 1.1 5, Business Telephone: 6. Business Address: 7. E-Mail:....5 r o,l;.,r J B, ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee.. 1. Are you duly registered to vote in Brevard County? 2, Have you been a resident of the City of Cape Canaveral for 12 months or longer? 3a. Are you a Business owner: 3b. If yes to 3a, please list the name: 4a. Have you ever been convicted r found guilty, regardless of adjudication, or a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. 4b. If yes to 4a, have your civil rights been restored? 5a. Co you presently serve on any other City of Cape Canaveral advisory board or committee? 5b. If yes to 5a, please list each: Page 1 of 3 (Y). X _ (N) (Y) __ (N) (Y)_ __.(N) k (Y)_. (N) (Y) (N) (Y) _ .. (N) City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a standard background check performed on you by the City of Cape Canaveral? 7a. Are you related to a City of Cape Canaveral Council member by blood, adoption, or marriage? 7b. if yes to 7a, please provide name(s) of person(s) and relationship to you: C. INTE EST'S/EXPERIENCE Briefly state your interest in s A L .rving on a City dvisory board or committee: fet, sr.,/ ittt A kdoelie initials (Y)( (Y) (N) 2. In numerical sequence (1 = most interestedTease rank which advisory board or committee on which you wish to serve: a. Board of Adjustment* b. Business and Economic Development Board c., Code Enforcement Board* d. Community Appearance Board e. Construction rioard of Adjustment arid Appeals* f.1 Culture and Leisure Services card g. Library Board h. Planning and Zoning Board* Other: *Members of these boards a required to complete and file with the supervisor of Elections a Financial Disclosure Form upon appointment to said board an prior to July 1 of each year following the initial appointment while still a member of s id board. 3. Briefly state any prior experiences in serving on any governmental board or co „m- kylr K Er ft. ittee: 4100, rf" 4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.) th t you feel hok to qualify y90 for membership on the desired board or committee. t b mit e /44 4r-4 if- V I kr AAA C,'C'eaeqt, 4 WO r r Art s k_c STATE REPORT! G RLQUIREMENTS Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender, and physical disabilities of board and committee members. Please check the appropriate boxes: Page 2 of CE African -American Asian-Annerican Hispanic -American NativeAmerica Caucasian Not Known GENJI ER DISH t JTY Male Female Not Known Physically disabled YOU HERE*Y REPRESENT TO THE CITY OF C PE CANAVE AL, UNDER PENALTY OF ERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCU TE TO THE EST OF YOUR KNOWLEDGE, AND 1HE CITY OF CAPE CANAVE'JAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNO LEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE L.AW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISO Y BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE 0 LIGATION AND DUTY TO COMPLY WITJ SUC LA S. PLEASE NOTE: Appointment to any City board is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. a Your application will remain effective for one year from date of completion. If you should have any questions regarding the completion of this application, please contact the City Clerk's Office at (321) 868-1220 ext. 221. Signature: Please return to: Date: City of Cape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral Florida 32920 MMIXMMMMMIAYMMIMMIMRVMMIIMMYMMINIMIAIKPMBXMY For Office Us Only: Date application received: Date Appointed: Appointed by: ..._, Board Aptointed to: Term Expires: M.10M111..11.1,1011.111.41MielnaNIMMIIIMI90.1.1111TIMMIMMIMI NI Page 3 of 3 CITY �JFCAPE CANAVERAL APPLICATION FOR APPOIMT88ENTTO�TY ADVISORY BOARD ORCOK0��7EE Pursuant to Section 2-171, Cape Canaveral Code Cdv'Code requires prospective and existing board members 1ofiU out an application. CdvCode o�o prohibits e person hnmn serving on o <�hv Board or Committee if that parson has been convicted of felony, unless their civil rights have been restored. P�aaeoonnp�tathefoUovvnginthespmceprovdad� �� 1� Applicant Name: /�/^K) 2. Home Address: {- v// 8� Hon�eand Cellular Tdeohone: '� �� 4. Occupation: '`-`°77�� 5. Business Telephone: �� 0. Business Address: 't//�� ' - l 7. E-Mail: --- --_J- �—' B. ELIGIBILITY )�/ ^/ ��._.» ~~_ ._ The information provided inthis section iofor purposes Vfdetermh�ngwhether you are eligible tooenxs onmCdvm��o�board moomm�e. 1�a�mdu��g�emd0ovo�hlB�vmndCnun�? A0 Z Have you been a resident of the City of Cape 0A 3a. Are you oBusiness ownec (y) 3b� �yes to3a.p�eoelist the man�e: ~«�/��_��__ �. Ho��ummr��dpr�undgu�.��b� ofadud�et�n.orah*�ny|nany juhmd��on?Any p�a v./w=^w.p"=Ulu v°v""""""v""="U "U"O""'""~ ~/ onnvi��nfor purposes ofthis queo�n. 00 (N) ~ 4b. |fyes h»4m.have your u�i|rights beonnaobzred? (Y) _ (N) 5a. Do you serve onany other CdvofCape Canaveral advisory board or committee? (y) (N) Canaveral for 12 months or longer? Page 1 of 3 0& O. City ordinance requires that all persons applying for o City advisory board orcommittee must voluntarily consent 1oastandard criminal background check before being appointed kzaboard orcommittee. Doyou voluntarily consent tnhaving astandard background check performed onyou bythe City oyCape Canaveral? 7o. Are you related tooChvnfCape Canaveral Council ~ member byblood, adoption, ornnarh—^/m0m? (Y) (�) �7bIf yes to 7a, please provide name(s) of person(s) and relationship to you: C. INTERESTSIEXPERIENCE 1Briefly state your interest inserving onaCity advisory board .orcommittee: -M rn a4.j/J-y 1AJ'VoLL/6;1-/M4A-6 `�-- 2� In numerical yequenue(1 = most |nhyraotmd), please rank which advisory board or committee on which you wish to serve: o. _ Board of Adjustment* b._ _ Business and Economic Development Board C. Code Enforcement Board* d� Community Appearance Board o._ Construction Board ofAdjustment and Appeals* [ -5 Culture and Leisure Services Board g. Library Board ' h. _ Planning and Zoning Board* i. Other: *Members ofthese boards are required to complete and file with the supervisor of Elections aFinancial Disclosure Form upon appointment to said board and prior to July f of each year following the initial appointment while still a member of said board. 3. Briefly state any prior experiences inserving onany governmental board nrcommittee: 4� Please list any specialized akU|oandtrmining(e.g,anchitaot, engineer, general contractor, etu) that you feel help to qualify you for membership on the desired board or committee, D. STATE REPORTING REQUIREMENTS Gactinn70O.8O. Florida Statutes, requires that the City annually submit areport bzthe Secretary ofState disclosing nsne, gender, and physical disabilities of board and committee members. Please check the appropriate boxes: Page 2 of 3 RACE GENDER African -American \-7 Male Asian -American Female Hispanic -American Not Known Native -American ‘..7" Caucasian DISABILITY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE ' [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LA S. PL SE NOTE: • Appointment to any City board is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. 6 Your application will remain effective for one year from date of completion. 6 If you should have any questions regarding the completion of this application, please contact the City Clerk's Office at (321) 868-1220 ext. 221. Signature: Please return to: City of�ape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral Florida 32920 For Office Use Only: Date application received: Date Appointed: Appointed by: Board Appointed to: Term Expires: Page 3 of 3 Date: F-1/51b'37 3 el ;ATI° CITY OF CA E CA AVERAL R APP T E T TO Cif ADVISORY 0 D 0 Pursuant to S ction 2-171, Cape Canaveral Code 1'0 IT City Code requires prospective and existing board members to fill out an application, City Code also prohibits a person from serving on a City Board or Co mittee if that person has been convicted of a felony, unless their civil rights have been restored. Please complete the following in the space provided: GENE 1 Applicant Name: 2. Home Addree;s: 3. Horne and Cellular Telephone: 4„ Occupation: \e L Business 'Telephone: 6. Business Address: 7„ E-Mail: B. ELIGI ITY 1 v The inf rmation provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee, 1„ Are you duly registered to vote in Brevard County? 2„ Have you been a resident of the City of Cape Canaveral for 12 rnonths or longer? 3a. Are you a Business owner: 3b„ if yes to 3a, please list the name: 4a. Have you ever been convicted or found guilty, regardless of adjudication, or a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. 4b lif yes to 4a, have your civil rights been restored? 5a. Do you presently serve on any other City of Cape Canaveral advisory hoard or committee? 5b, If yes to 5a, please list each: Page 1 of 3 (N) (Y) (N) (Y) (N) 6. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee„ Do you voiunt rily consent to having a standard background check performed on you by the City of Cape Canaveral? Are you related to a City of Cape Canaveral Council member by blood, adoption, or marriage? 7b, if yes to 7a, please provide name(s) of person(s) and relationship to you: C. ERESTS/EXPERIENCE (Y) (N) 1. Briefly stateyour interest in se ..on a City advisory board or committee: 2. In numerical sequence (1 = most interested)„ please rank which advisory board or committee on which you wish to serve: a. Board of Adjust ent* h. Business and Economic Development Board c. Code Enforcement Board* d. Community Appearance Board e. Construction Board of Adjustment and Appeals* Culture and Leisure Services Board g Library Board h. Planning and Zoning o- rd* Other: *Members of these boards are required to complete and file with the supervisor of Elections a Financial Disclosure Form upon appointment to said board and prior to July 1 of each year Wowing the initial appointment while still a member of said board. 3. Briefly s a eany prior experiences in serving on any governmental board or committee: ) . 06, 4. Please list any specialized skills and training (e.g., architect, e that yom fe help Ihs_gualify y u fo rnrnbershn the desire gineer, general contractor, etc.) ord or committee. ST TE, REPORTING 't'EQ IRE ENTS Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender, and physical disabilities of board and committee members. Pease check the approprite boxes: Page 2 of 3 CE African -American Asian -American Hispanic -American Native-Arnerican Cucasian Not Known DISABILITY Male Female Not Known Physically disabled YOU EREBY REPRESENT TO TrLE CITY OF CAPE CANAVERAL, UNDER PENALTY OF PE*JURY, THAT HE INFORMATION PROVIDED 1EEIN IS TR E AND ACCUATE TO THE EST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CA AVERAL AS THE RIGHT TO ELY Ohl THAT INFORMATION. YOU HERE Y ACKNOWLEDGE THE EXISTE CE OF THE CODL OF ETHCS FIR PUBLIC OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTIO 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO Y U IF YOU RE APPOI TED TO A CITY A VISORY BOAR OR CO ITTEE, AND IF APPONTEP, Ir'T IS YOUR SOLE OBLIGATION AND DUTY TO CO PLY WITH S CH LAWS. PLEASE NOTE: Appointment to any City board is subject to City Council approval following a brief nteview before the City Council at a regularly sche uled meeting. • Your application will remain effective for one year from date of completion, • Vf you should have any questions regarding the complr;tion of this application, please contact the City Clerk's Office at (321) 868-1220 ext. 221, Signature: Please return to: City of Cape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral Florida 32920 For Office Use Only: E;44e a plication receiv Date Appoi ted: ppointA by: Board A o ted to: Tern::,:. Expires: Page 3 of 3 CITY OF CAPE CANAVERAL APPLICAN FC APOI T M ENT TO CITY ADVISORY BOA r" OR CO I EE ursuantt to aectio2 171, C Canaw�r°, l , City Co.�e a° a prospective and existing La zard members to fill application. e also prohibits a person fro serving on a City hoard or Committee if that xon has been convi ed f a felony, unless their civil rights have been restored, Pie se complete the f llo ing in the space provided: A. GE ERAL 1. 2, AppUicant Naanc. ...._._. Home Address, Home and Cellular °felephonea m. 4. Occupation: ni 5w Business Telephone a__-___._-� 5� Bsiness Ad ELIGIBILITY t�:i Co1 The irafotion provided in this section is for purposes oof determining whether you a are eligible to serve on a City advisory board or committee, 1 Are you dBy registered to vote in Brevard Cnty? 2 e you t raen a resident of the City of Cape averal for 12 months or longer? 3a. Are you a Business owner: 3b if yes to 3a, please list the name: 4a. Have you ever been convicted or fouras'. guilty, regar Ue� of adjudication, or a felony in ny jurisdiction? Any plea of nolo contendere ( o contest) shall be considered a conviction for purposes of this question.. slam If yes t. 4a, have your civil rights bee restored°' ;,. D, you presently serve on any other City of Ca Canaveral advisory ha card or conaritt e? 5h, if yes to 5a, please UUst each, _ I Page 1 of 3 (N) (N) _._... (Y) _.._ _.._ (Y) ._._.__..u_.._ (. 6, City ordinance requires that all persons applying fir City advis ry b ard or co r rnitte must voluntarily consent to a tansad crirniniA background check before being appointed ard sr corn *tee, Do you voluntarily consent to having a standard backgro nd check performed o you y the City of Cape Canaveral? Are you related to Ct of Cape Canaveral Co nul ember by bl od, adoption, or marriage? '7b„ if yes to 7a, please provide name(s) of person(s) and relationship to you: INTERESTS/EXPER1ENCE (Y) 1 Briefly state your interest in serving n a City advisory board c.mrrutlee: ,14hr,iflv iNti. 0 1: CieCbA (3i4L Afip-1 6,400c, . In numerical se uence (1 = rriost interested), please rank which advisory board or co mttee n hich you sh to serve: ard „ f Adjustment* rosiness and Economic Developrnent B Code Enforcement Board* Comm nity Appearance Board Construction B ard of Adjust ent and Apr Culture and Leisuio, Services Board Library Board Pianning and Zoni g Board*. Other: ard a *Members of these boards are required to complete and file ith the supe ioi of Elections a Financial Disclosure For pon appointment to said board and prior to July 1 f ach year folio hg the initial appointment while still a member of said oard 3 Briefly state any prior e.xperiences in serving on any governmental boa d ommttee: /IC (3i211' 4.5c 4 Please list any specialized skills and training (e.g„ architect, engineer, general contractor, etc„) that you feel help to qualify you for me bership on the desired boaa or comments /67 0,4 -r en. et Pi 7-4 174c- S1— ,„•57 (4/24(1 5 STATE REPORTING QUIREIVIENTS Section 760,60, Florida Statutes, requires th4I the City a ally submit a report to the Secretary of State disclosi g race, gender, and physical disa ilities of board and committee re, mbers„ Please check the appropriate boxes: Page 2 „ 13 RACE African -American Asian -Arne rcan Hispanic -American ative-American Caucasian Not Kno n YO HEREBY PERJMtY,, T BEST OF YO 0 THAT INFOR I*" EPRESENT T T THE INF0RMATO KNOWLEDGE, A ATION, Vj DISABILITY a a Female Not Known Physically disabled E CITY OF CAPE CANAVE" AL, JNDER PENAL •F P OVIDED EEl IS T UE AD ACCURATE TO THE D THE CITY OF CAPE CAN VERAL HAS THE RIGHT TO ELY YO ,ERE Y ACKNOWLEDGE THE XISTENCE OF THE CODE OF ETHICS FOR PU LIC OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] All THE FLORIDA "SUNSHINE L " [SECTION 286.011, FLO* IDA STAT TES], WHICH AY PE A TO Y U IF YOU ARE APPOINTED TO A C Y ApVISORY BOARD OR COMMITTEE, AN F A POINTED, IT IS YO R SOLE 0" LIGATION A D DUTY TO COMPLY WITH SUCH LAWS, PLEASE N•TE: Appointment to any City bard it3 subject to City Council appr val too Nng a brief intervie before the City Council at a reg larly scheduled meeting_ Y ur application will remain effective for one year from , ate of completion. If you should have any questions regarding the completion of this application, the City CeAs Office at (321) 868-1220 ext, 221. Sigiy.ture: Please return to: City of Cape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral Florida 32920 VOWNODMI For Olitic Us Date ap Only: cation received: Dat A oint d: Appoi ted $ y: Board Appointe T .rm Expires: Pag : cif 3 Date: ease „ontact CITY OF CAPE CANAVE- L APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR CO ITTEE Pursuant to Section 2-171, Cape Canaveral Code City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony, unless their civil rights have • - -n restored. Please complete the following in the space provided: A. 1. 2. 3. 4, 5. 6. 7, B. GENE L Applicant Name: y,t/ /1/ e /K5- H e Address: %-e) DEG Ae'D acP:(1,1-1/1- H e and Cellular Occupation: 4. 7-7,./er.0 Business Telephone: /// /3 Business Address: 4-/ E-Mail: 14..7' z Ye573 ELIGIBILITY The information provided in this section is on a City advisory board or committee. 1. Are you duly registered to vote in Brevard County? 2., Have you been a resident of the City of Cape Canaveral for 12 months or longer? 3a. Are you a Business owner: 3b. If yes to 3a, please list the name: 4a. Have you ever been convicted or found guilty, regardless of adjudication, or a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. 4b. If yes to 4a, have your civil rights b n restored? 5a. Do you presently serve on any other City of Cape Canaveral advisory board or committee? 5b. If yes to 5a, please list each: Page 1 of 3 r purposes of determining.whether you are eligible to serve (Y) (N) (Y) (N), (Y) (N) (Y) (N) (Y) (N) (Y) (N) 6. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily consent to having a standard background check performed on you by the City of Cape Canaveral? 7a. Are you related to a City of Cape Canaveral Council member by blood, adoption, or marriage? 7b, If yes to 7a, please provide name(s) of person(s) and relationship to you: C. INTERESTS/EXPERIENCE (Y) J,Z(N) (Y) (N) 1. Briefly state your interest in serving on a City advisory board or committee: /VCC/ 7.4 42re4' /9 4.e.)0z-d Aeeine, "noce- 2//766'd 1;1 74h/ g(9,-)7191/1,1 7- 4; 2, in numerical sequence (1 = most interested), please rank which advisory board or committee on which you wish to serve: a. Board of Adjustment* b. Business and Economic Development Board c. Code Enforcement Board* d. Community Appearance Board e. Construction Board of Adjustment and Appeals* f Culture and Leisure Services Board g. Library Board h. Planning and Zoning Board* Other: *Members of these boards are required to complete and file with the supervisor of Elections a Financial Disclosure Form upon appointment to said board and prior to July 1 of each year following the initial appointment while still a member of said board. 3. Brie y state any prior experiences in serving on any govern enta board or committee: (29/°,4,7e-ri ',773, ge,e24, viZr 7-,74a ZI:'/Xf /19 "Ira 4. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.) that you feel help to qualify you for membership on the desired board or committee. &,i / a..74 11,/ c/671 D. STATE REPORTING REQUIREMENTS Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender, and physical disabilities of board and committee members. Please check the appropriate boxes: Page 2 of 3 RACE African -American Asian -American Hispanic -American Native -American Caucasian Not Known GENDER DISABILITY Male Female Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTY OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW" [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. PLEASE NOTE: • Appointment to any City board is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. • Your application will remain effective for one year from date of completion. • If you should have any questions regarding the completion of this application, please contact the City Clerk's at (321) 868-1220 ext 207. Signatur Please re u City of Cape Canaveral Office of the City Clerk 100 Polk Avenue Cape Canaveral Florida 32920 For Office Use Only: Date application received: Date Appointed: Appointed by: Board Appointed to: Term Expires: jfrfiar Page 3 of 3 Date: