OFFICE OF THE SECRETARY OF STATE 

ADVISORY COMMITTEE ON PARTICIPATORY DEMOCRACY APPLICATION 

NRS 225.200-.270 addresses the Advisory Committee on Participatory Democracy including composition of the Committee and duties. 

 Pursuant to NRS 225.240(3)(a), the Secretary of State is required to consider political, geographical and demographical factors in appointments. Please complete each section below.

Basic Information

1

 Contact Information:

 *

Contact Information:

First Name	Middle Initial
Last Name	Street Address
City	State/Province
Zip/Postal Code	Country
Personal Phoneext.	Business Phoneext.
E-mail

2

If Representing an Organization:

 *

If Representing an Organization:

Organization Name	Street Address
City	State/Province
Zip/Postal Code	Country
Organization Phoneext.	Organization E-mail

3

Why do you want to serve on this Advisory Committee?

 *

Why do you want to serve on this Advisory Committee?

4

Please describe your qualifications.

 *

Please describe your qualifications.

5

Please provide a short bio (if appointed, this bio will be used to announce your appointment) 

 *

Please provide a short bio (if appointed, this bio will be used to announce your appointment)

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