2. Name*
4. Phone*
6. Address*
8. E-mail *
10. Describe your occupation and brief background: (link to resume may be included)*
12. Number of years as a Dania Beach resident*
14. Are you a registered voter? *

    1. Yes
    2. No
16. Explain why you are interested in serving on a city board
18. List community/civic associations in which you are involved
20. Please indicate the board(s) in which you have an interest:

    1. Charter Review Board
    2. Dania Beach Housing Authority*
    3. Education Advisory Board
    4. General Employees Pension Board*
    5. Green Advisory Board
    6. Marine Advisory Board
    7. Parks, Recreation And Community Affairs Advisory Board
    8. Planning And Zoning Board*
    9. Police And Fire Pension Board*
22. Please attach resume with detailed financial experience for Police & Fire Pension Board or any other document you wish to include.
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field