Forms • Hallandale Beach • CivicEngage

First Name:*

Last Name:*

Address:*

Phone Number:*

How Long Have you Lived in Hallandale Beach:*

Current Occupation:*

Days Available to Attend Meetings:*

	Thursday
	Friday

Hours Available to Attend Meetings:*

	Mornings
	Middays

	Afternoons
	Nights

Volunteer Experience/Professional Experience:*

Why Do You Want To Serve On the Ad Hoc Parking Committee?*

Indicated which of the following areas in which you live:*

	Three Islands Area (Includes Three Islands Boulevard, Parkview Drive and Leslie Drive)
	South Ocean Drive
	Golden Isles and Diana Drive

	Northeast Area (Includes Diplomat Parkway, N.E. 14th Avenue and N.E. 12th Avenue)
	Atlantic Shores Boulevard

What special qualifications do you feel you would bring to this committee?

* indicates required fields.

Disclaimer: Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact the city by phone or in writing.