8/8/2019 Greater Blue Mountains World Heritage Area Advisory Committee Application Form

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25-34 35-44

Occupation:

45-54 55-64

Employer (optional):

Nominated by: Self Local Government

Aboriginal organisation ** other please specify

EEO Statistics: Please tick the applicable categories:

English is your first languageEnglish is not your/your parents first languageAboriginal or Torres Strait Islander descent Person with a disability

under 25

Dr/Mr/Mrs/Ms Surname:

Other Names:

Residential Address:

Post code:

Postal address (if different):

Post code:

Telephone: Business: Home:

Mobile:

Fax: Business: Home:

Email:

Age range: 65 and over

Qualifications for Advisory Committee membership.Expertise and experience in local governmentExpertise and experience in community involvement in conservation Expertise in Aboriginal Cultural Heritage

Scientific qualifications in the area of conservation (please select one):-botanical/ecological archaeological/culturalzoological/ecological water quality/aquatic

Expertise and experience in tourism or ecologically sustainable visitor use,enjoyment and appreciation of reserves

Indigenous/traditional ownerExpertise in outdoor self reliant nature based recreation

Expertise in non-Aboriginal cultural heritage conservation

APPLICATION FOR APPOINTMENT AS A MEMBER OF THE

GREATER BLUE MOUNTAINS WORLD HERITAGE AREA ADVISORY COMMITTEE

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Office use

Reg no:

Rec:

Ent:

Ack:

Appt: Y

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**For Aboriginal nominations, please attach written endorsement from your local Traditional Elders.

8/8/2019 Greater Blue Mountains World Heritage Area Advisory Committee Application Form

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To support my application, I have the following experience/expertise/qualifications:

(If nominating for more than one area of expertise, provide supporting evidence for each area. Attach a separate

sheet if necessary.)

Professional/trade qualifications:

Details of any relevant activities or interests:

Have you previously served on a NSW National Parks and Wildlife Service Advisory

Committee or World Heritage Advisory Committee? (Please provide details.)

Membership of or affiliation with relevant organisations:

Other remarks relevant to your application (attach extra page/s if required):

If I am appointed to the committee I authorise the public disclosure of my name, my town orsuburb of residence, qualifications, occupation and organisational affiliations.

Signature: Date:

(Signature not required on emailed applications)

APPLICATIONS CLOSE: 5pm 15 October 2010

Please mail to: Jacqueline ReidWorld Heritage OfficerNSW National Parks & Wildlife ServicePO Box 552 Katoomba NSW 2780

Or email to: jacqueline.reid@environment.nsw.gov.au

Or fax to: (02) 4782 6199

Enquiries: (02) 4784 7326

GBWHAA

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