Request to Appear Before the Durham City Council

2. Today's Date
   Today's Date

3. Session Date*
   -- Select One --December 20, 2018January 10, 2019January 24, 2019February 7, 2019February 21, 2019March 7, 2019March 21, 2019April 4, 2019April 18, 2019May 9, 2019May 23, 2019June 6, 2019June 25, 2019August 8, 2019August 22, 2019September 5, 2019September 19, 2019October 10, 2019October 24, 2019November 7, 2019November 21, 2019December 5, 2019December 19, 2019January 9, 2020

4. First Name*

6. Last Name*

7. Address

9. City

10. State

11. Zip Code

13. Email

14. Phone Number

15. Fax Number

17. Organization Represented

19. Topic*

    Statement of action you wish the council to take.

21. Presentation

    1. Yes

    1. No

    Will you be presenting a PowerPoint presentation, or a video?

22. Communication

    1. Yes

    1. No

    Have you communicated with the Department Director associated with this matter?

24. Please Note: You are permitted 3 minutes to speak and make your presentation.
    
    This form must be submitted to the Agenda Coordinator by Monday at 5 p.m. 10 calendar days prior to the City Council Work Session meeting at which you wish to speak. Once this form is submitted, no further reminder will be given. Citizens may call the Agenda Coordinator's Office at 919-560-4222 to confirm receipt of this form.

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field