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Cou4~il of La?rdscape Architectural Registration Boards .3949 Pender Drive, Suite 120, Fairfaz, VA 22030 . Phone 571-432-0332 . Fax 571-432-0442 <br /> ANNUAL ACTIVITY REPORT <br /> For the Period of: 7/01/2007 to 6/30/2008 <br /> Instructions: Please complete each section of this form with typewriter or black ' ~ Date: Tuesday, July 1, 2008 <br /> Council Record ID: 2577 o~~ Please lis any Chan es below. LIC <br /> g <br /> Scott Milovich ~ A <br /> Ci Of Eu ene <br /> g <br /> Public Works Engineering, 858 Pearl Street <br /> i <br /> ~ Eugene, OR 97401 <br /> c~QD~ <br /> Email: scoff.r.milovich@ci.eugene.or.us <br /> Daytime Telephone: (541) 682-6086 <br /> i <br /> A. REGISTRATION: List one current Landscape Architecture Registration. If unlicensed, please write "none." <br /> Jurisdiction Date Acquired Registration Number Expiration Date <br /> i <br /> 1=Gtfl o ~Z 5 a? ~ ~ <br /> During the period listed above: <br /> 1. Have you acquired any additional landscape architect registrations? Q Yes ~No <br /> 2. Have you been denied registration or disciplined by a registration board? Q Yes ~ No <br /> 3. Has your registration been revoked or limited in any jurisdiction? Q Yes No <br /> 4. Have you allowed your registration to lapse in any jurisdiction? 0 Yes No <br /> 5. Have you passed astate/provincial examination in any subject? Q Yes ~No <br /> i <br /> If you have answered "yes" to any of the above, please provide full details on an attached sheet. <br /> i <br /> j B. EDUCATION: List any additional education and/or degrees acquired during the period listed above. pl~, <br /> i <br /> School Course of Study Dates of Attendance Degree or Credit <br /> Hours Earned <br /> <br /> f <br /> C. EXPERIENCE: Indicate the name and address of all employers for the period listed above.. <br /> Full name and complete, current Dates of Part Time Check appropriate experience <br /> ~ address of Employer Employment or Gen? Pract. Teaching or Public Other <br /> mm/yy t0 mm/yy Full Time Land Arch. Research Service (Explain) <br /> G. X1'7 ~'q~.Nr? 2. tl ' l v, <br /> 14 r S ~~l 1 <br /> ~ ~ <br /> D. AFFIDAVIT: I declare that I am the person making the foregoing statements, that they are made in good faith and are <br /> true in every respect. <br /> Signature: Date: g„ <br /> 290 5450 <br /> <br />