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NFMDRP NOMINATION FORM-FINAL ONE
May 24, 2010

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NOMINATION FORM
NORTH FORT MYERS DESIGN REVIEW 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 6/4/10 This is a volunteer, 2-year term.
In order to serve on this Panel, you must be either:
1)   A licensed or registered professional involved with building, planning or designing, including but not limited to an 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 the first Tuesday of every month, 6 p.m. at The Theatre Room, North Star Yacht Club, Hancock Bridge Parkway, N. Ft. Myers. 33903
 
__________________________________________________          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, specify license#:_______________________________________________________________________________________________________________________________________.
 
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:
 
 
 
 

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