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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 j J
NAME ORGANIZATION
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HOME/WORK ADDRESS�i�� CITY/ZIP CODE
HOMEWORK PHONE NO. E-MAIL ADDRES C, Ark
(please indicate one)