Form 1120-19 - Bureau Of Land Management Resource Advisory Council Application (Page 4 of 5) in pdf

Form 1120-19 - Bureau Of Land Management Resource Advisory Council Application Page 4

Indicate the specific area(s) of interest you seek to represent:

Category 1:

I hold a Federal grazing permit within the committee's area of jurisdiction.

I represent transportation or rights-of-way interests.

I represent developed outdoor recreation, off-highway vehicle users, or commercial recreation activities. I

represent the commercial timber industry.

I represent energy and mineral development interests.

Category 2:

I represent a nationally or regionally recognized environmental organization.

I represent dispersed recreation interests.

I represent archaeological and historical interests.

I represent wild horse and burro interest groups.

Category 3:

I hold State, county, or local elected office.

I am an employee of a State agency responsible for management of natural resources, land, or water. I

represent an Indian tribe within or adjacent to the Committee's area of jurisdiction.

I am an academician involved in natural resource management or the natural sciences.

I represent the affected public-at-large.

Indicate any BLM permit, leases, or licenses that you hold personally or are held by your employer:

Are you a federally registered lobbyist?

Is at least one letter of

Yes

recommendation attached or has a

letter been sent on your behalf by

the interest group or organization

that you wish to represent?

Signature

Date

Form 1120-19 - Bureau Of Land Management Resource Advisory Council Application Page 4