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By filing this application with the City of Cocoa Beach, I do hereby acknowledge the following: 1) This application when completed is a public record and open to public inspection. 2) I am responsible for keeping information current with the City. 3) I consent to the filing of the State Form, Statement of Financial Interest (Form 1), if required by the Board. (http:/www.ethics.state.fl.us/ethics/forms.html). 4) If appointed, it is my obligation to comply with the State of Florida Code of Ethics. 5) I acknowledge that I will have adequate time to serve on the Board/Committee. The information provided on this form is true and correct.

I understand that the City will acknowledge receipt of my Board/Committee application and that my application will remain active for 6 months from the date of submission.
If I am selected to serve on a Board/Committee, the City will notify me, otherwise if not selected, I will receive no notice. At any time, I may withdraw my application by contacting: cityclerk@cityofcocoabeach.com.