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2. * Indicates a Required Field
4. Complete this form if you would like to speak at a Board meeting, or if you have a comment you'd like read at a Board meeting.
6. Meeting Date*
   Meeting Date
8. I would like to speak to something*

   1. On the Agenda
   2. Not on the Agenda
10. I would like to address the Commissioners about a topic on the agenda*
12. I would like to address the Commissioners about a topic that is NOT on the agenda*
14. Name*
16. Title (if applicable)
18. Representing *

    1. Self
    2. Group / Org
20. Group or Organization *
22. Address 1*
24. Address 2
26. City*
27. Zip*
29. Phone*
30. Ext.
32. Email*
34. How would you like to be heard *

    1. Submit Comment to be Read at the Board Meeting
    2. Speak at the Board Meeting
35. Message*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field