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2. Regular Meeting Speaker Request Form

   Please begin your remarks by stating your name and address.

   Direct your comments to the Chair. Please refrain from addressing any individual member of the Board, Staff, or other members of the audience.

   Keep your comments pertinent to your chosen subject matter. Refrain from making personal remarks that challenge the integrity or competency of any staff member.

   Please avoid being repetitive and refrain from using inappropriate, offensive, or vulgar language. You will have a reasonable amount of time to speak, as determined by the Chair, during the Public Comments section.

   Please keep in mind that this is your opportunity to address your comments and concerns to the Board as a whole. Board members and/or staff WILL NOT answer questions or enter into a discussion with you.

   Code of Conduct (PDF)

6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip*
15. Phone Number:
16. Email Address*
18. Today's Date*
    Today's Date
22. Date of Meeting*
    Date of Meeting
24. I will speak for myself*

    1. Yes
    2. No
26. I will speak on behalf of:
30. Do you wish to speak during the 1st Public Comments section which is dedicated to comments specifically related to items featured on the agenda?
    
    Do you wish to speak during the 2nd Public Comments section, featured prior to the close of the agenda, which is dedicated to anything the public wishes to address?*

    1. 1st public comments

    1. 2nd public comments

    1. Comments submitted for meeting minutes
32. I wish to speak during the Public Hearing section of the meeting regarding the following item (Please Indicate Subject Matter):*
34. In reference to the subject matter above, my comments are:

    1. In favor of the subject.
    2. In opposition to the subject.
38. I do not wish to speak, but I would like the following comment submitted to be included in the official record (Please be advised your comment will not be read aloud, but it will be included in the minutes of the meeting):
42. Disclaimer:
    Information submitted on this form will be sent via email. To protect sensitive information, do not include the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field