Form 1120-19 - Resource Advisory Council Application Page 4
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5Indicate 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
Yes
recommendation attached or has a
No
No
letter been sent on your behalf by
the interest group or organization
that you wish to represent?
Signature
Date
4
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