HomeMy WebLinkAboutSPEAKER FORMS 10-04-11CITY 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. 13/
PUBLIC INPUT kd
..................._.............................._....................................................................................................._....................................._...........................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE VC --Cb BES It
NAME c t1 "�S LA�ie �'
�ORGANIZATION S
(
MAIL ADDRESS
(please 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. ❑
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER?
NAME
PUBLIC INPUT
TODAY'S DATE /O- `7(- I 1
h
- ",
_E-MAIL ADDRESS
(please 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
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE ILI La® CC
NAME l'81Q1(Z#�- (� L! f�% C�-S ORGANIZATION �-T0P0C- Y1 A4;L-ry k T* PS
ADDRESSh
(PleasehidtEate 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 INPUT
.................._.........................................._.........................................._..............................................._..................................................................................
IN FAVOR ❑ OR OPPOSITION ❑ TO MATTER? TODAY'S DATE / 61— Y— /
NAME
GANIZATION
(if applicable)
OM ORK ADDRESS
MAIL ADDRESS
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 INPUTEl
......._..............__....................................................._..........,...............................................................................................................................................
IN FAVOR [:]OR OPPOSITION [:]TO MATTER? TODAY'S DATE r b - 'YJ- //
NAME DO ZI�Y Du AL ORGANIZATION � l�CLa,1-t )2A;o_)
(if applicable) -�^ p
HOMEMORK ADDRESS
MAIL
(please 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 INPUT
IN FAVOR ❑ OR OPPOSITION TO MATTER? TODAY'S DATE
NAME O �Ld �� ORGANIZATION
(if applicable)
HOMEWORK ADDRESS /�'�-
(pleas dicate 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— JA ORGANIZATION
(if applicable)
S'
HOME/WORK ADDRESS CITY/ZIP CODE
-, ),
HOME/WORK PHONE NO. E-MAIL ADDRESS
(please indicate one)