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2. Speaker's Name*
   (Any person wishing to speak on behalf of a group shall so indicate and shall identify the name and address of the group or organization.)
4. Address*
6. Phone Number*
7. Email Address*
9. Topic to be addressed*
11. Council Meeting Date
    Council Meeting Date
13. I Agree*

    1. I Agree

    By checking "I Agree" you agree and acknowledge your electronic signature is valid and binding in the same force and effect as a handwritten signature.
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15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field