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2. Please check the boards / committees you are interested in:*

   1. Community Redevelopment Agency
   2. Recreation Advisory Committee
   3. Planning & Zoning Board
   4. Retirement Advisory Committee
   5. Youth Council
6. Personal Information
8. First Name*
9. Last Name*
11. Address*
13. Business Address (if applying for CRA as a business owner)
15. Address2
17. City
18. State
19. Zip
21. City*
22. State*
23. Zip*
25. Home Phone Number*
26. Work Phone Number*
28. Email Address
29. Occupation*
33. Residency Information
35. Length of Residency or Business Ownership in Groveland*
37. Are you a registered voter*

    1. Yes
    2. No
41. Education, Profession and Hobbies
43. High School
45. College
47. Trade or Business School
49. Present / Past Employment
51. Hobbies
55. Organization Membership Information
57. Are you currently serving on other Boards, Commissions, or Committees?*

    1. Yes
    2. No
59. If yes, which:
61. Have you served on a Board, Commission, or Committee before?*

    1. Yes
    2. No
63. If yes, which:
65. Community Involvement
    (Civic organizations, PTO, etc.)
67. Areas of Special Interest
68. Areas of Special Expertise
72. Acknowledgment*

    I understand that in accordance with Florida Sunshine Law, the above information is considered a public record.
    
    I understand that appointment to any of the positions listed above is a voluntary service and is not compensated.
    
    I understand that an appointment to any of the above boards or committees subjects me to the Florida Sunshine Law.
    
    If appointed, I agree to faithfully perform the duties of my office, make every endeavor to serve my foil term, and will comply with all laws or ordinances of the City, County and State of Florida, particularly those pertaining to the conduct of public office and the financial disclosure requirements, if applicable to my position.

    1. I have read and understand.
74. Electronic Signature*
    To electronically sign this form, please type your name in the field above and use a forward slash ( / ) before and after your name. Example: /FirstName LastName/
Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit Submit and Print

* indicates a required field