JOHNSON COUNTY APPLICATION FOR WYOMING PUBLIC …

JOHNSON COUNTY APPLICATION FOR WYOMING PUBLIC LANDS INITIATIVE

ADVISORY COMMITTEE

The core goal of the Wyoming Public Lands Initiative (WPLI) is to develop a locally-led, Wyoming-specific, legislative lands package to address designation, release, or other management for Wilderness Study Areas in Wyoming. The WPLI is a voluntary project initiated and led at the county level through a collaborative process that will culminate in legislation forwarded to Wyoming's Congressional delegation for introduction.

(Please Type or Print)

NAME: __________________________________________________________ DATE: _________________

Last

First

Middle

MAILING ADDRESS: ______________________________________________________________________

Street

City

State

Zip

TELEPHONE (Daytime) ____________ (Evening) ____________ E-Mail Address ______________________

JOHNSON COUNTY RESIDENT? YES _____ NO _____

IF YES, HOW LONG? _________________

COUNTY OF RESIDENCY IF NOT FROM JOHNSON COUNTY

ARE YOU REGISTERED TO VOTE IN THE STATE OF WYOMING? YES _____ NO _____

MEMBERSHIP CATEGORY APPLYING FOR:

_____AGRICULTURE/RANCHING

_____SPORTSMAN

_____MOTORIZED RECREATION

_____CONSERVATION

_____ENERGY

_____NON ?MOTORIZED RECREATION

_____GENERAL PUBLIC

_____OTHER (PLEASE SPECIFY)

EDUCATION / OCCUPATION / EXPERIENCE

College/Vocational Training/Other: ________________________________________________________________________________________ Occupation: _______________________________________________________________________________________ Work Experience:

_______________________________________________________________________________________ Special training pertinent to the goals of this Initiative:

_______________________________________________________________________________________

How have you worked collaboratively with a diverse group of interests to accomplish a common goal or solve a problem?

_______________________________________________________________________________________

Have you ever visited the Gardner Mountain or North Fork Wilderness Study Area? If so, share your experiences?

_______________________________________________________________________________________

1. What memberships or affiliations do you have to interest groups within the category of representation you are applying for? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

2. Can you make a one year time commitment to this Advisory Board? ____________________

3. If chosen, how will you maintain a good line of communication with the constituent groups and interests parties you have been selected to represent in the collaborative process? ________________________________________________________________________________________ ________________________________________________________________________________________ _______________________________________________________________________________________

4. Describe your experience working on cooperative natural resource planning efforts? ________________________________________________________________________________________ ________________________________________________________________________________________ _______________________________________________________________________________________

5. Will you commit to do homework and other participation as needed? __________________________

6. Can you travel to proposal sites? ______________________________________________________

7. Are there any forms of land designations you would not ever consider supporting (wilderness, hard release, multiple use, ACEC, recreation classifications, etc.)? ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

8.

If not chosen for the Advisory Committee, what specific areas would you be interested in serving on for

subcommittees? __________________________________________________________________________

9. Disclose any conflicts of interest you may have regarding the two wilderness study areas?

ADDITIONAL COMMENTS

I certify that all the statements herein are true.

Signature: ___________________________________________________ Date: ______________________

RETURN COMPLETED APPLICATION TO: JOHNSON COUNTY COMMISSIONERS 76 North Main Street BUFFALO, WY 82834 commissioners@johnsoncowy.us (307)684-7555 (307) 684-9118 (FAX)

Johnson County selects people on the basis of their qualifications and with assurance of equal opportunity and treatment, regardless of race, creed, religion, color, sex, age, national origin, ancestry or disability.

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