EXHIBIT 15-D
MPWMD
Public Ownership Advisory Committee Questionnaire
August
15, 2011
Please answer
the following questions and return the completed form to the address shown
above by September 26, 2011. You may also email the completed
questionnaire to MPWMD Executive Assistant, Arlene Tavani at arlene@mpwmd.net
or fax it to 831-644-9560.
Contact Ms. Tavani at 658-5652, if you have any questions. Your response will be important to the
Board’s determination regarding POAC membership. Thank you for responding to
this questionnaire!
1)
Name of Organization
______________________________________________________________
Contact Person ____________________________________________________________________
Mailing Address
___________________________________________________________________
Telephone Number ______________ and Email
Address ________________ of Contact Person
2)
This organization is interested is not interested (circle one) in having a representative serve on an MPWMD
Public Ownership Advisory Committee.
3)
If
not interested, please provide a brief explanation for the reason(s).
4)
Please
provide your organization’s comments, questions or suggestions that the
District Board should consider related
to the committee charge or that the committee should consider in completing its
analysis.
5)
Name, title and signature of person
responding to this questionnaire on behalf of your organization.
Name
__________________________________________________________________________
Title
_______________________________
Signature ___________________________________
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