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	Address* Please enter your address including apt or suite #.

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	Zip Code* Please enter your 5 digit zip code. (Any additional numbers in your zip code are not necessary.)

	Email Address* Please enter a valid email address. (For example: youremail@website.com)

	I wish to Speak About:*
	--Please Select--An Item on the AgendaPublic Testimony on Items Not Listed on the Agenda (to be heard in the first 30 minutes or at the end of the meeting.)

	If speaking about an item on the agenda, enter the agenda number below, such as, E.1. Please leave blank if speaking on non-agenda items. NOTE - Non-agenda testimony is heard at regular board meetings only. (Submit individual request forms for multiple items.)

	Select Meeting Date: NOTE - If preferred board date does not appear in drop-down menu, electronic sign up is closed. Please sign up in the auditorium or conference room prior to the start of the board meeting.*
	--Please Select--May 28, 2013; 5:00 p.m. (Regular Board Mtg)June 4, 2013; 5:00 p.m. (Regular Charter Mtg)June 18, 2013; 5:00 p.m. (Regular Board Mtg)June 25, 2013; 5:00 p.m. (Regular Board Mtg)

	Support Recommendation (for agenda items ONLY):
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	Brief Description* Please enter a brief description of the subject of your hearing.