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2. Last Name*
3. First Name*
4. District # You Live In.*
6. Home Address*
7. City*
8. State*
9. Zip Code*
11. Home Phone
12. Cell Phone
13. Email Address*
15. Owner or Renter *
16. Number of years as city resident*
17. Are you registered to vote in Broward County?*
    -- Select One --YesNo
18. Education (highest degree / level)
20. Occupation*
21. Work Phone
23. Business Name*
25. Business Address
26. City
27. State
28. Zip Code
32. How many elections have you voted in and when was the last time you voted?*
34. How many City Commission or board meetings have you attended in the last 2 years? Please list:*
36. Why do you wish to serve as a member of the Emerald Hills Safety Enhancement District Board?*
38. If appointed, what specific contribution(s) will you bring to the Emerald Hills Safety Enhancement District Board?*
40. Please describe your qualifications as an applicant including your professional and/or volunteer experience or background.*
44. Do you currently serve on any City or County boards or committees? Please list.*
46. Have you ever served on any City or County advisory boards? Please list.*
48. List community / civic service involvement.*
50. 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).*
52. Attach Resume (only .doc and .pdf files)*
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54. 1. Receive an email copy of this form.
55. Email address

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56. Submit

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