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2010 STAKEHOLDER APPLICATION for APPOINTMENT to the MRRIC

Please Note: All information on this form will become part of the public record. Please read all of the accompanying information prior to submitting the application.

If you would prefer, you may fill out the form, print, and then fax or send. Please use the Hardcopy Form.

General Information

Name:
Business Address:
City:	State: Zip Code:
Business Email:
Business Phone:	Fax: Mobile:

Area(s) of Interest

Formal Endorsement as Preferred Representative

Formal designation or endorsement by an organization, local government, or constituency as its preferred representative is required. Please include a signed, formal letter or letters of designation or endorsement with this application. If you have letters of endorsement for both your primary and secondary areas of interest, please include both. Signed endorsement letters may be sent via fax, mail, or e-mail, as noted at the end of this application.

Statement of Qualification

Please briefly describe your primary area of interest and state why you feel you
are qualified to be appointed to represent this interest on the MRRIC.

* Please keep responses to this and the following text areas limited to 2500 characters.
A character counter is provided in the lower left of each text area.

0 of 2500

Participation on the MRRIC

Please briefly state how your participation as a Stakeholder Representative will fulfill
the roles and responsibilities of the MRRIC.

0 of 2500

Contribution to Overall Balance

Please briefly state how your appointment as a Stakeholder Representative
would contribute to the overall balance of interests represented on the MRRIC.

0 of 2500

Communication Network

Please briefly describe the communication network that you would use to inform
your constituents and gather their input and feedback.

0 of 2500

Primary or Alternate Representative

Please check one of the following boxes: I am applying for appointment as the PRIMARY representative. I am applying for appointment as the ALTERNATE representative.
If applying for PRIMARY representative my recommended ALTERNATE is:
If applying for ALTERNATE representative my recommended PRIMARY is:

** The recommended alternate/primary must fill in a separate application.

Deadline and Submission Information

Deadline
Please submit a completed application package before July 30, 2010

Address
By Mail
US ARMY Corps of Engineers
CENWO-PM-C, ATTN: MRRIC
1616 Capitol Avenue
Omaha, NE 68102-4901

By Email
info@MRRIC.org
Please put "MRRIC" in the subject line.

By Fax
402-995-2758

Certification

By checking the box below, I certify that I:

Have read the MRRIC Charter;
Have read Section 5018 of WRDA 2007;
Have read the factsheet for MRERP;
Agree to support and adhere to the MRRIC Charter and Operating Procedures;
Am able to commit the time required to participate fully in the Committee;
Am committed to acting in good faith (as defined in the MRRIC Charter) to seek balanced solutions that address multiple interests and concerns;
Have included a signed, formal letter of endorsement from an organization, local government, or constituency stating that I am its preferred representative;
Have verified that all information on this form is complete, correct, and true to the best of my knowledge;
Am aware that this application will become part of the public record.
Have read the Operating Procedures.

Date: 09/09/2010