Name of Group _____________________________________________________
Primary Purpose _____________________________________________________
Names of Officers _____________________________________________________
Mailing Address _____________________________________________________
Telephone Number _____________________________________________________
email Address ___________________________________________________________
Designated Representative
Name ________________________________________________
Mailing address` ________________________________________________
Telephone Number ________________________________________________
email Address(s) ________________________________________________
Membership in groups ________________________________________________
Interest/Expertese ________________________________________________
Time Available/Month ________________________________________________
Representative
Would be interested in (check if yes):
Becoming an officer _________
Being on a Working Group
Aquifer, Storm Water/HIRTF/Mosquito Lagoon ________
Beach, Turtles________
Sprawl________
Revision of Laws and Regulations ________
Wildlife, Native Plants, Manatees ________
Being an Agency Watcher
County Council ________
City Commission of City _________________________
St Johns River Water Management District ________
US Army CorpEng ________
Metropolitan Planning Organization ________
Environmental and Natural Resources ________
Any suggestions for working groups, or comments:
Sign and Date
Name ________________________________________________
Mailing address` ________________________________________________
Telephone Number ________________________________________________
email Address(s) ________________________________________________
Membership in groups ________________________________________________
Interest/Expertese ________________________________________________
Time Available/Month ________________________________________________
Would be interested in (check if yes)
Becoming an officer _________
Being on a Working Group
Aquifer, Storm Water/HIRTF/Mosquito Lagoon ________
Beach, Turtles________
Sprawl________
Revision of Laws and Regulations ________
Wildlife, Native Plants, Manatees ________
Being an Agency Watchers
County Council ________
City Commission of City _________________
St Johns River Water Management District ________
US Army CorpEng ________
Metropolitan Planning Organization ________
Environmental and Natural Resources ________
Any suggestions for working groups, or comments:
Sign and Date