NFMCPP NOMINATION FORM
NOMINATION FORM
NORTH FORT MYERS COMMUNITY PLANNING PANEL
Please complete and send to John Gardner, Chairman,
North Ft. Myers Community Planning Panel by email to
john@LCIQuotes.com, via fax to 239-6560640, mail to 390 Pondella Road#1, N. Ft. Myers, Fl. 33903. DEADLINE 5/28/10 This is a volunteer, 2-year term.
In order to serve on this Panel, you must be either:
1) A licensed architect, landscape architect, professional engineer, general contractor, Hydrologist, Environmental Specialist or a person with a professional degree in land use, planning or urban design; or
2) A full time resident of North Fort Myers.
The Panel meets at least quarterly and as needed.
__________________________________________________ NAME
________________________________________________ TELEPHONE #s (home, work &cell)
ADDRESS__________________________________________
Are you a full-time resident here? If not, explain when you do reside in N. Ft. Myers.
___________________ __________________________
Fax #: e-mail address:
If you are a licensed or degreed person as defined above, specify the name of the license, where and when earned, what state(s) you are or were licensed in, are you currently licensed, and if so,specifylicense#:_______________________________________________________________________________________________________________________________________.
EDUCATION: SCHOOLS AND THEIR LOCATIONS, CURRICULUM, DEGREES EARNED, ETC.__________________________________________________________________________________________________.
RESUME OF YOUR WORK HISTORY, AND PROFESSIONAL AND SOCIAL ORGANIZATIONS TO WHICH YOU CURRENTLY OR FORMERLY BELONGED:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.
CAN YOU THINK OF ANY PROJECTS, ASSOCIATIONS, INDIVIDUALS, ETC. WHEREIN YOU MIGHT HAVE A CONFLICT OF INTEREST, OR SHOULD DISQUALIFY YOURSELF? If so, please describe each such situation.____________________________________________________________________________________________________________________________________________________________________________________________________.
OTHER THINGS WE SHOULD KNOW ABOUT YOU: ____________________________________________________________________________________________________________________________________________________________________________________________________________.
STATE WHY YOU WANT TO SERVE: ________________
______________________________________________________________________________________________________.
SIGNATURE OF NOMINEE DATED: