PCBOC - Request to be placed on the Agenda

Pike County Board of Commissioners

Request to be placed on the Agenda
All members of the public that should wish to address the Board must submit their name and the topic and specific subject matter of their comments via this form (or in writing) to the clerk of the Board at least four business days before the Board meeting. These individuals will be allowed five minutes to make their comments and their comments must be strictly limited to their chosen topic and the specific matter set forth in the request. At no time will personal attacks on County employees be permitted.
For Meeting Date:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Please consider my request for the following item to be placed on the above noted Agenda as:*

Invited GuestsPublic Comment
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Topic/Subject:
Signature

Clear
Should be Empty:

Pike County Board of Commissioners