San Juan Islands National Monument Resource Advisory Committee Application - Bureau Of Land Management Page 3

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Indicate the specific area(s) of interest you seek to represent:
I represent recreation and tourism interests
I represent wildlife and ecological interests
I represent cultural and heritage interests
I represent an Indian tribe within the committee's area of jurisdiction.
I represent education and interpretation interests
I represent private landowners
I represent the affected public-at-large.
Indicate any BLM permits, leases, or licenses that you hold:
Are you a federally registered lobbyist?
Yes
Is at least one letter of
Yes
No
recommendation attached or has a
No
letter been sent on your behalf by
the interest group or organization
that you wish to represent?
Signature ________________________________
Date __________________
Be sure to sign and date application. Print and mail application and letter(s) of recommendation to:
BLM Spokane District Office
attn. San Juan Islands RAC
1103 N Fancher Road
Spokane, Washington 99212

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