HomeMy WebLinkAboutSPEAKER FORMS 03-01-11REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................................................................................................................................................................................................................................................
AGENDA ITEM NO. ❑ / PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION M TO MATTER? TODAY'S DATE
NAME -e_6 r f G -A S Chi ORGANIZATION f'1/(,P /i
(if applicable)
CITY/ZIP CODE
HOMEWORK PHONE NO. E-MAIL ADDRESS
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................................................................................................................................................................................................................................................
AGENDA ITEM NO. ❑ PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR [-]OR OPPOSITION 4 MATTER? TODAY'S DAT
E l
7 % �V
NAME /� / ORGANIZATION
(if applicable)
HOMEWORK ADDRESS
HOMEJ@R PHONE NO
(please indicate one)
CITY/ZIP CODE /44 %��A
E-MAIL ADDRESS
i
I
sCITY OF Tusm
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REQUESTrF
• SPEAK'1
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................................................................................................................................................................................................................................................
AGENDA ITEM NO. ❑ PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE
NAME /��/o^fthj� ORGANIZATION
E-MAIL ADDRESS
(please indicate one)
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
AGENDA ITEM NO. ❑_ PUBLIC INPUT
..................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE
NAME ORGANIZATION
�+ (if applicable)
HOMEIWORK ADDRESS �
E-MAIL ADDRESS
(please indicate one)
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................................................................................................................................................................................................................................................
AGENDA ITEM NO. ❑ I PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION [ r0 MATTER? TODAY'S DATE
NAME f T
ORGANIZATION [1/��,
(if applicable) &syca ek vo k ' I , „
HOMEWORK ADDRESS _
E-MAIL ADDRESS
(please indicate one)
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
AGENDA ITEM NO.
..............................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE Z Q 1 1
NAME % �G j G� ORGANIZATION�rlGu-
(if applicable)
HOMEWORK ADDRESS �� �'°'
CITY/ZIP CODE
PUBLIC INPUT ❑
HOMEWORK PHONE NO. `�� E-MAIL ADDRESS
(please indicate one)
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
......................................................................... I ...............
AGENDA ITEM NO. PUBLIC INPUT ❑
................................................................................................................................_......- -
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE
NAME14 '45 ORGANIZATION
CITY/ZIP CODE T
HOMENIVI..__O//RKPHONE NO.
E-MAIL
(please indicate one)
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
...................................... ............................................................. .............................................................................................................................................
AGENDA ITEM NO. L� _L PUBLIC INPUT ❑
....................................................................................................................................................................................................................... I.......................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE /�'G
NAME /lJ/`L I " f ` ORGANIZATION
(if applicable)
HOMEWORK ADDRESS
E-MAIL ADDRESS
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................................................................................................................................................................................................................................................
AGENDA ITEM NO. P PUBLIC INPUT ❑
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION t,TO MATTER? TODAY'S DATE / O 11
NAME Y `� v �%'�ORGANIZATION
(if applicable)
HOMEWORK ADDRESS �
MAIL ADDRESS
ase indicate one)
CITY OF TUSTIN
REQUEST TO SPEAK
Providing the following information is strictly voluntary. Only your name will appear in the
official Minutes of this Meeting. The other information may be used by staff to contact you.
Please complete and submit this form to the City Clerk/Recording Secretary.
................. _.......... _................ ... ......... .. ......... ........
AGENDA ITEM NO. ❑ PUBLIC INPUTJ�,
................................................................................................................................................................................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE /i (
NAME V �Y� Yi+i'Vl [%CXI',� ORGANIZATION &Vvff
(if applicable)
HOMEWORK ADDRESS
E-MAIL ADDRESS�
(please indicate one)