PELICAN BAY NEIGHBORHOOD AND COMMUNITY ADVISORY COMMITTEE

INFORMATION STATEMENT AND COMMITTEE APPLICATION

DATE:

NAME: HOME PHONE:

STREET ADDRESS: CELL PHONE:

BUSINESS PHONE:
MAILING ADDRESS: Do you own property in Pelican Bay?

Location:
Are you a citizen of the U.S.A. ____Yes ____No Are you a registered voter? ____ Yes ____ No
How long immediately prior to this date, have you been a resident of the City of Pelican Bay?
__________________
How long immediately prior to this date, have you owned land or property in the City of Pelican
Bay? _____________
Have you been convicted of a felony? If so, please explain:
Professional / Education / Work Background:

Current Occupation: Current Employer:

Previous Community Service or Experience:

What is your interest in serving on this committee?

Do you have special knowledge, interest or experience that would qualify you for a position on
this committee?

Thank you for taking the time to complete this application. The information will be helpful to the members of City Council in making
appointments. You will be contacted before any action is taken on your appointment.
Please return this form to: City of Pelican Bay, Attn: City Secretary, 1300 Pelican Circle, Azle, TX 76020

________________________________________ __________________________________
Signature of Applicant Date