Nebraska Administrative Code › Topic - GAME AND PARKS COMMISSION › Title 163 - Nebraska Game and Parks Commission › Chapter 1 - Administration Regulations › Attachment 163-1-2

Current through June 17, 2024
BEFORE THE Game and Parks Commission STATE OF NEBRASKA
In the Matter of the Negotiated )
Rulemaking Committee for ) Application/Nomination
[Insert name of the proposed ) for membership
Negotiated Rulemaking Committee], ) on the committee.
163 NAC ____
APPLICATION FOR MEMBERSHIP
(complete if applicable)
1. The undersigned person (the applicant)
				hereby applies for membership on the above-referenced Negotiated Rulemaking
				Committee proposed by this Commission.
___________________________________
Name of applicant (typed or printed)
__________________________________________________
Full address of applicant
___________________________________
Applicant's telephone number
(including area code)
2. The applicant represents the following
				identifiable interest which will be significantly affected by the proposed
				administrative rule to be considered by the above-referenced negotiating
				rulemaking committee:
3. The
				applicant is authorized to represent parties related to the interest listed
				above because:
4. The applicant can
				adequately represent the parties and interest listed above because:
5. In support of their application, the
				applicant has attached the following documents to this petition (list all
				attachments):
6. By signing this
				application, the applicant hereby certifies that they will represent the
				interest identified above to the best of their ability in the negotiation
				process, and that the applicant is willing to actively negotiate in good faith
				to reach a consensus on the proposed rule to be considered by the
				above-referenced Negotiated Rulemaking Committee.
______________________ Date ________________
Signature of Applicant
NOMINATION FOR MEMBERSHIP
(complete if applicable)
1. The undersigned person (the nominating
				party) hereby nominates the following person (the nominee) for membership on
				the above-referenced Negotiated Rulemaking Committee proposed by this
				Commission.
__________________________________
Name of nominee (typed or printed)
__________________________________________________
Full address of nominee
___________________________________
Nominee's telephone number
(including area code)
2. The nominee represents the following
				identifiable interest which will be significantly affected by the proposed
				administrative rule to be considered by the above-referenced Negotiated
				Rulemaking Committee:
3. The
				nominee is authorized to represent parties related to the interest listed above
				because:
4. The nominee can
				adequately represent the interest and parties listed above because:
5. In support of the nomination of the
				nominee, the nominating party has attached the following documents to this
				petition (list attachments):
6. The
				nominating party believes that the nominee will represent the interest
				identified above to the best of their ability and that the nominee is willing
				to negotiate in good faith to reach a consensus on the proposed rule to be
				considered by the above-referenced negotiated rule making committed because:
_____________________________ Date _______________
Signature of Nominating Party
____________________________________________
Name of nominating party
(printed or typed)
_________________________________________________________
Full address of nominating party
______________________________________________
Telephone number of nominating party
(include area code)