Nebraska Administrative Code › Topic - GAME AND PARKS COMMISSION › Title 163 - Nebraska Game and Parks Commission › Chapter 1 - Administration Regulations › Attachment 163-1-3

Current through June 17, 2024
BEFORE THE Game and Parks Commission STATE OF NEBRASKA
In the Matter of the Negotiated )
				  Application/Nomination
Rulemaking Committee for ) for membership
[Insert name of the proposed ) on the committee
Negotiated Rulemaking Committee], ) (interest
				  inadequately
163 NAC ____ . ) represented)
APPLICATION FOR MEMBERSHIP
(complete if applicable)
1. The undersigned person (the applicant)
				hereby applies for membership on the above-referenced Negotiated Rulemaking
				Committee.
___________________________________
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 being 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. Reasons that persons already serving on
				the above-referenced negotiated rule making committee do not adequately
				represent the interest listed in paragraph 2 above include:
6. In support of the application, the
				applicant has attached the following documents to this petition (list all
				attachments):
7. 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 they are willing to actively negotiate in good faith to reach
				a consensus on the proposed rule being 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.
__________________________________
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 being 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 listed above because:
5. Reasons that persons already serving on
				the above-referenced negotiated rule making committee do not adequately
				represent the interest listed in paragraph 2 above include:
6. In support of the nomination of the
				nominee, the nominating party has attached the following documents to this
				petition (list all attachments):
7.
				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 actively 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)