NCFLEPC - Nomination form

NORTH CENTRAL FLORIDA
LOCAL EMERGENCY PLANNING COMMITTEE
2009 NW 67th Place, Gainesville FL 32653-1603 -- (352) 955-2200 x108 -- fax 955-2209

LEPC Nomination Form

The mission of the North Central Florida Local Emergency Planning Committee is to increase chemical safety in our communities. The LEPC represents 11 counties and 18 occupational categories. The LEPC is currently seeking nominees for the July 2008 through June 2010 term. LEPC members are subject to Government in the Sunshine regulations and are subject to approval by the State Emergency Response Commission. Past participation in LEPC activities, occupational category and residence county may be considered when determining which nominations are forwarded to the State Emergency Response Commission. If you have any questions regarding membership, please contact LEPC Director Dwayne Mundy at (352) 955-2200 x108 or email mundy@ncfrpc.org .

Note: When submitted, this form is emailed using your email system. If you do not have JavaScript and an SMTP email server, the form can not be submitted online. The form can also be printed and faxed to 352-955-2209 or mailed to

Ms. Edye Rowell, Chairman
North Central Florida LEPC
2009 NW 67th Place
Gainesville, FL 32653.

Person making nomination, if not self-nomination:
Recommendation: (Optional)

Occupational Category :
Member or Alternate:
First & Last Name:
Job Title:
Organization:
Division:
Street:
City, State:
Zip code:
County:
Phone:	Fax:
Email:
Web site:
Other Comments: (Optional)

Or complete and print this form and return to:

  Ms. Edye Rowell, Chair
  North Central Florida LEPC
  2009 NW 67th Place
  Gainesville, FL 32653


  Fax: 352-955-2209

This form will be submitted using your email system.