Request to Speak During City Council Work Session

2. Today's Date
   Today's Date

3. Session Date*
   -- Select One --January 23, 2020February 6, 2020February 20, 2020March 5, 2020March 19, 2020April 9, 2020April 23, 2020May 7, 2020May 21, 2020June 4, 2020July 23, 2020August 6, 2020August 20, 2020September 10, 2020September 24, 2020October 8, 2020October 22, 2020November 5, 2020November 19, 2020December 10, 2020December 22, 2020January 7, 2021

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:


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

    This field is not part of the form submission.

28. Submit

* indicates a required field